Diabetes - The Medical Perspective
Your healthcare team will develop a plan to help manage your diabetes. This will likely include changes to your eating plan, physical activity, and medications. Even if insulin is not a part of your care plan, it is important to understand its role, as diabetes is a progressive disease with ever changing strategies for management.
Insulin is a hormone produced by the pancreas that keeps blood sugar within normal ranges in the blood stream. Insulin moves the sugar (glucose) from the blood stream into the cells to nourish the body. Everyone with type 1 diabetes requires insulin injections because their body produces little or no insulin. Some with type 1 diabetes go through a period referred to as a “honeymoon phase” shortly after diagnosis, where the pancreas may still produce a small amount of insulin. This phase can last weeks or months, but is temporary, resulting in the need for insulin injections.
The following are common assumptions made about insulin that are not accurate:
If I have to take insulin, I must be a failure.
It is not uncommon for those with type 2 diabetes to eventually need insulin because diabetes is a progressive disease. Few people with type 2 diabetes start out taking insulin, but about one in three will end up taking insulin. The necessity for insulin injections should never be viewed as a failure.
Taking insulin means my diabetes is somehow more serious.
Insulin is a natural way to keep your diabetes well managed and prevent diabetes related complications. It is most important to manage diabetes with the best medical therapy available.
Insulin injections are painful.
Most of us do not relish the thought of having to take daily injections. Insulin is injected into the fat right beneath the skin where there are few nerve endings. The pen needles and insulin syringes of today are so thin that most people report little to no discomfort.
I will never be able to give myself a shot.
Young and old alike can be taught how to administer an insulin injection. Special adaptive devices are available for those with poor dexterity, vision issues, or fear of needles.
I will gain weight on insulin.
Taking insulin can make weight loss more difficult, although decreasing caloric intake and increasing physical activity play the greatest role in weight status. If you do gain weight, talk to your dietitian and health care provider about making sure the meal plan and insulin plan are the best for you.
If I agree to start insulin, it will be forever.
Anyone with type 1 diabetes will have to take insulin forever. For others, it depends on how long you have had diabetes and how much insulin your pancreas is able to secrete. Many with type 2 diabetes can reduce or eliminate the need for insulin with the adoption of healthy lifestyle behaviors, like weight loss and increased physical activity. Newly developed diabetes medications can sometimes replace insulin.
Insulin will cause low blood sugar.
Low blood sugar (hypoglycemia) can happen with insulin; however, careful dosing, monitoring and meal planning makes hypoglycemia less common. The use of long-acting insulins has lessened hypoglycemia occurrences because these insulins do not peak like regular and fast-acting insulin.
Diabetes and Food
No matter what medication is prescribed for diabetes management, a healthy eating plan is an important part of the treatment plan. Healthy meals are a balance of lean protein, fruits, vegetables, whole grains, fat-free or low-fat dairy products, and healthy fats.
Eating regularly scheduled meals and snacks, as appropriate, will maintain blood glucose control. When taking insulin and some oral medications that can cause hypoglycemia (low blood sugar), it is especially important not to skip meals and to monitor your blood sugar before periods of physical activity.
Blood glucose readings below 70 mg/dl are hypoglycemia and should be treated with a fast acting carbohydrate. The only way to be sure you are experiencing hypoglycemia is to check your blood glucose level at the time symptoms occur. Common hypoglycemia symptoms include a rapid heart rate, shakiness, chills, sweating, anxiety, lightheadedness and dizziness. The lower the blood sugar reading, the more pronounced the symptoms.
Treat hypoglycemia by consuming 15-20 grams of glucose or a simple carbohydrate. Wait 15 minutes and recheck your blood glucose. If hypoglycemia continues, consume an additional 15-20 grams of carbohydrate. Once blood sugar returns to normal, eat a small snack if your regularly scheduled meal is more than an hour or two away.
Examples of simple carbohydrates to treat hypoglycemia include:
- Glucose tablets – follow package directions
- Gel tubes – follow package directions
- 4 ounces regular soda or fruit juice
- 2 tablespoons of raisins
- 8 ounces fat-free or low-fat milk