Insulin: Myths and Facts

By Dr Sunil Kumar Kota

Insulin is a hormone produced by beta cells of pancreas. It regulates the levels of glucose in the blood by unlocking the cells for entry of glucose, so that glucose can enter the cells and be used as source of energy. It also helps in synthesis of protein, lipids in the body. There are 2 patterns of insulin secretion. Insulin secreted during fasting state is known as Basal Insulin. Another is the secretion of insulin which increases in response to increased blood glucose levels after taking food, is known as Prandial insulin.

In type 1 diabetes, the pancreas fails to produce insulin from the beginning itself. Therefore these patients need insulin therapy for ever. In Type 2 diabetes, the pancreas initially produces insulin, but the cells are unable to make good use of the insulin (insulin resistance). Subsequently the insulin level also declines gradually over a period of time. Initially Type 2 diabetic subjects require oral drugs which extract insulin from our body and let that insulin to reduce blood sugars. In a long term, when the body gets depleted of insulin, the oral drugs fail to act, a condition known as oral drug failure. At this stage, people with Type 2 diabetes must also take insulin therapy to control blood sugar levels and avoid complications.

Insulin is given as injections beneath the skin either through syringes or pens or the newer format of insulin pump. Sometimes in acute complications, insulin is given through veins. Insulin is usually injected into the abdomen, but it can also be injected into the upper arms, thighs, or buttocks. Injection sites should be rotated within the same general location.

Myth: Insulin means patient is a failure or diabetes is serious
Fact: Type 2 diabetes is a progressive disease with gradual decline in pancreatic beta cells and resultant reduction in body insulin levels. Therefore insulin is a logical step for treating when other medicines no longer keep your blood glucose levels under control. If doctor advises for insulin therapy in order to control diabetes, that does not mean the patient is doing anything wrong or the condition is getting worse. Insulin is simply a tool to manage blood sugar level better

Myth: Insulin does not work
Fact: Insulin injections mimic natural insulin produced by the body, and thus it is the best way to lower the blood Glucose.

Myth: Insulin is difficult to take
Fact: Gone are the days when insulin injections were bulky, conspicuous, and difficult to administer. Today, insulin comes in pen injectors that are easy to carry with, don’t require refrigeration, and can be used discreetly, often just once a day

Myth: Oral medications are better than insulin
Fact: Most of the oral drugs are agents of insulin, they act via insulin only. Initially Type 2 diabetic subjects require oral drugs which extract insulin from our body and let that insulin to reduce blood sugars. In a long term, when the body gets depleted of insulin, the oral drugs fail to act. At this stage, people with Type 2 diabetes must also take insulin therapy to control blood sugar levels.

Myth: Insulin once started would always lifelong
Fact: For people with type 1 diabetes, this is true. In type 2 diabetics, when insulin is given after maximum doses of drugs fail to lower the sugar, in those cases by and large insulin injections are always permanent. Whenever a diabetic person well controlled on oral drugs is subjected to any stressful situations like fever, surgery, pregnancy, dental extraction or any other illnesses etc, insulin is given temporarily to control the sugars till the stress subsides. After that, the oral drugs are resumed. Oral drugs fail to act during states of stress.

Myth: Insulin causes complications.
Fact: Starting insulin earlier in fact can even prevent or delay the complications related to diabetes.

Myth: Insulin injections are painful
Fact: With rotation of injection site, the pricks are almost painless. Newer insulin pen needles are very small and thin; thus pain is negligible.

Myth: Insulin is too expensive
Fact: Insulin is usually less expensive compared to using oral medication. Once on insulin, the number oral intake of drugs intake is also curtailed significantly.

Myth: Insulin means that patient’s life will change
Fact: Patients’ life could change for better. Many people feel more energetic and positive after starting insulin with significant improvement in quality of life.

Myth: Taking Insulin Will Make patient’s Life More Complicated.
Fact: True. But the additional work of taking proper care of your diabetes today will help prevent the complications of diabetes in the future and help you to live a healthier longer life.

Myth: Insulin causes weight gain
Fact: Some patients on insulin are prone to gain weight. But this is usually minimal. This is also true if they take oral medications that stimulate the pancreas to produce extra insulin. In fact majority of weight gain is due to unhealthy diet and lifestyle. Consulting a dietician would be helpful before initiating insulin to achieve its benefits.

However, sometimes the initial weight loss arising out of very high blood sugars gets reverted with insulin as, the body begins to process blood glucose more normally, and the result can be weight gain.

Myth: Insulin causes hypoglycaemia
Fact: Hypoglycemia is fall of blood glucose. It gets manifested as excessive hunger, blurring of vision, headache dizziness, irritability, sweating, fatigue, fast heart beat and shakiness of hands. It generally happens with inadvertent use of higher dose of insulin, absence of food intake following insulin or any coexisting illnesses. In the era of newer insulins, hypoglycaemia events are less. Knowledge of preventing, recognizing and treating hypoglycaemia helps in better management of diabetes. Some of the oral drugs are also stopped to avoid excess hypoglycaemia due to insulin

Myth: Insulin can make me go blind.
Fact: False. There is absolutely no evidence that insulin treatment causes blindness. In fact, it is almost the opposite that is true: if you do not control your diabetes, you can eventually lose your eyesight. The Diabetes Control and Complications Trial showed that proper treatment of diabetes with insulin reduced the risk of eye disease by as much as 76%.

Myth: People will think I am a drug addict if I carry a syringe
Fact: If the patient reveals to his friends, family, and co-workers about diabetes, they will know that insulin is being injected and patient is not a drug addict. However, some uninformed people have been known to jump to the wrong conclusion when they see a person with diabetes injecting insulin.

If a patient is asked why you have a syringe, the proper reply would be is “I have diabetes and I have to inject insulin.” If this person insists on asking questions or making comments that are pushy or tacky, try to end the conversation quickly and politely. Fortunately, most people are aware of what insulin injection is, so patients should not run into this problem. And if the patient would rather not tell anyone about his condition, he/she should try carrying the insulin supplies in a zippered case and inject in private.

Dr Kota, MD (Medicine) and DNB (Endocrinology) is presently the Consultant Endocrinologist and Diabetes, Thyroid Superspecialist at Diabetes & Endocare Clinic, Berhampur. He can be contacted at +91-9668600444 and Email: diab.endocare@gmail.com