Insulin is a hormone produced by the pancreas, a gland which lies behind the stomach.
Insulin allows glucose in the blood to get into the cells where it can be used for energy or storage.
Insulin can not be swallowed as the acid the stomach will destroy, so it needs to be injected
WHY INSULIN THERAPY?
For people with Type 1 diabetes insulin is the ONLY treatment Insulin will be started as soon as Type 1 diabetes is diagnosed.
This is because there is NO insulin produced naturally by the pancreas. The insulin producing cells in the pancreas (beta cells) are being destroyed. So insulin needs to be started as soon as type 1 diabetes has been diagnosed.
Type 2 Diabetes
The majority of people with diabetes, have Type 2 diabetes. Which means they are “resistant to insulin” (their own insulin doesn’t work very efficiently) and there don’t have enough insulin to maintain blood sugars within the normal range 4-7mmol/l.
Initially combinations of dietary changes, increasing physical activity and oral tablets will be advised to keep blood sugars at satisfactory levels to maintain health and reduce the risk of complications.
The problem is that type 2 diabetes is progressive, and as time goes by, the beta cells become more damaged and produce less & less insulin. This means that when the tablets can no longer keep blood sugars at satisfactory levels, insulin will need to be started.
Approximately 50% of people with type 2 diabetes will require insulin after being diagnosed with Type 2 diabetes for 7-10 years.
WHAT DOES INSULIN DO?
Insulin helps move sugars in the bloodstream into the cells of your body that need the sugar for energy. By doing this insulin controls and maintains your blood sugars at satisfactory levels. (Between 4mmol-7mmol)
WHEN SHOULD INSULIN BE STARTED?
Your diabetes team will be supporting you to manage your diabetes, and a regular blood test known as HbA1c will determine what your average blood sugars are over a three month period. Generally you should aim to have a HbA1c level of 7% or 53 mmol/mol below if you are at risk of diabetes complications eg heart disease or stroke, then it should be 6.5 % or 48 mmol/mol.
BUT I ALREADY TAKE TABLETS?
If you are on maximum and the highest dose of tablets, eating the recommended diet, and being as physically active as your general health allows and still finding that your blood sugars are high and you have a raised HbA1c your diabetes team will start recommending insulin be initiated.
It is perfectly normally to feel anxious about starting insulin. Everybody worries that they won’t be able to cope with administering injections, that it will be very painful and that they may make a ‘mistake.’
What’s important to remember is that insulin will make you feel better, give you more energy, take away any symptoms you may have and improve your blood sugar control. Your diabetes team will help and support you through the processes and will be available for advice and on-going help. See Insulin initiation groups
This is very important, as when you start insulin you will only be started on a small dose, probably insufficient for your needs. Testing blood sugars allows you to learn so much about your diabetes you should develop a much better understanding of what effects your diabetes and how to make insulin work for you to achieve desired targets.
The diabetes nurse and doctor will need to review your blood sugars so they can discuss with you how you can change your insulin doses and what targets you should be aiming for.
NOW THAT I AM ON INSULIN WHAT WILL I NEED TO DO?
Now that you are on insulin you there are a few necessary changes you will need to make.
Always carry your identity card. Include your gp name and number, medications, and the kind of insulin you are taking. What to do when your blood sugar drops too low.
Tell your family, friends and employer and workmates what to do in emergencies. Eg hypos
If you hold a current driving licence you are by law required to inform the DVLA of the change. See DVLA website
Your car insurance will need to be updated and you will need to take more precautions when driving to prevent accidents. SeeEmployment, Driving and the DVLA
It is important to make a note of the type of insulin you are taking, the delivery method, (e.g. pen) the dosage you have been prescribed and the time when you need take it.
LONG TERM AIM
The long term aim for most people with diabetes on insulin is that you learn how to make decisions about your insulin dose through monitoring your own diabetes and experiences.
Insulin is unlike other medicine you may get from your doctor because the dose you require at each injection may vary dependent on the food you are eating, your personal lifestyle, activities and wellbeing or illness.
You diabetes team will help you self manage your insulin therapy and diabetes.
