‘Starting Insulin Means I Have to Take It For Life:’ Myths, Busted

Five things you may have misunderstood about insulin as a treatment for diabetes.

Many patients develop inertia to insulin therapy based on hearsay, despite all scientific evidence to the contrary.

This has an impact on their diabetes management and increases the risk of complications. Patients often get stressed when they are told to start on insulin because they feel that adopting insulin therapy could be too overwhelming for them.

I would like to address some common misconceptions about the use of insulin so that patients see its value as an excellent means of controlling blood sugar and reducing complications. Some of the misconceptions that I want to address are as follows:

Misconception #1: Insulin therapy means my diabetes has reached a serious stage

Fact: The truth is that people with type 1 diabetes require insulin and must take it for life, since their pancreas cannot make any insulin at all. Patients with type 2 diabetes, except those with very high blood sugar levels at the time of diagnosis, only require insulin after oral drugs fail to keep their blood sugar under control. The management of diabetes is usually multifactorial and blood sugar control is one of the most important factors, especially early in the disease. Insulin has the highest blood sugar reduction potential of all anti-diabetes medicines and though there are issues with hypoglycemia and some weight gain, these can be handled easily if patients regularly follow up with their physician and get involved in their therapy. Many studies have shown that insulin initiation does not hamper quality of life.

Misconception #2: Insulin injections are very painful

Fact: This may have been true a while back but not any longer. Today’s insulin injections are virtually painless, with micro thin needles, which makes insulin easy to self-administer. There are insulin pens available today that are equipped with an insulin cartridge and disposable needles, which are simple enough for even children to use. The doctor can teach you how to take the shot and help you practice until you are confident enough to do it yourself.

Misconception #3: There is a higher risk of hypoglycemia with insulin therapy

Fact: It is true that insulin therapy may cause unexpected dips in blood sugar levels, but this is more a problem of dosage adjustment than the insulin itself. When your doctor puts you on insulin you will be given detailed instructions on how to recognize the signs of hypoglycemia, how to prevent it and when to contact your doctor and/or healthcare team. Also, patients when put on insulin therapy should monitor their blood sugar regularly to prevent and/or avoid hypoglycemia.

Misconception #4: Long distance travel will become impossible after insulin

Fact: Traveling with insulin is not difficult at all. The important thing is to maintain a proper cold chain, which means carrying insulin in ice packs for journeys over 6-8 hours, especially in the summer months. People who travel by air should keep the insulin in their cabin luggage and not in their check in luggage. Inform the airline and security about this. For long duration flights, you can ask the flight attendant to keep the insulin in the galley’s cold storage till you need it. Most importantly, please speak with your doctor about your travel plans and how best to manage your insulin schedule. Follow your physician’s instructions carefully at all times during your travel.

Misconception #5: Starting on insulin means I’ll have to take it forever

Fact: Patients with type 1 diabetes usually require insulin for longer periods of time. For patients with type 2 diabetes, insulin can be used for shorter periods, especially if introduced early on in their disease following diagnosis. However, insulin when started late in the course of type 2 diabetes might have to be taken for longer periods of time.

(Dr. Subhash Wangnoo has over 33 years of experience and is a Sr. Consultant Endocrinologist at Apollo Centre for Obesity, Diabetes & Endocrinology, Indraprastha Apollo Hospitals, New Delhi. He is also Honorary Physician Endocrinologist to the President of India.)