When Do People With Type 2 Diabetes Start Insulin
After 10 to 20 years, many people with type 2 diabetes will begin insulin therapy, although every persons journey with type 2 diabetes is different. This happens when lifestyle changes and medications arent keeping your glucose levels in your target range. It is important that you start treatment as early as possible to avoid persistent hyperglycemia , which can lead to long-term health complications affecting your heart, kidneys, eyes, and other organs.
Try Injecting Insulin At Room Temp
Unopened insulin should be stored in the refrigerator, but an open insulin vial and cartridge can be safely left out at room temperature for up to 28 days. And injecting it at room tempbetween 59 and 86 degreesmay actually be more comfortable. Injecting cold insulin may sting a bit, explains Dr. Miller. You also want to avoid extreme temperature changes, which can spoil your supply. So dont store it in your car or leave it next to the air conditioner, he advises.
First Resist Insulin Resistance
A 2020 study in Diabetic Medicine showed that more than 40% of patients initially decline insulin. Theres a stigma attached to insulin that experts want to break: If you have an ear infection, you take an antibiotic. If you have asthma, you may use an inhaler. If your pancreas doesnt make enough insulin, you take insulin, says Joshua D. Miller, M.D, medical director of diabetes care at Stony Brook Medicine in Stony Brook, NY. Theres no blame or guilt. It may be a short-term fix or a long-term solution, depending on the progression of the disease.
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New Oral Drugs Or Insulin
Traditionally metformin plus a sulfonylurea has been the mainstay of oral treatment. Patients understandably often want to know whether they should try adding a third drug or begin insulin. The addition of acarbose can usually only decrease the HbA1c by 0.5% at best, so one would only consider its use if a slight improvement in control is needed. Repaglinide and sulfonylureas should not be used in combination, as they are both insulin secretagogues. The response to therapy with a thiazolidinedione can be more profound with improvements in HbA1c of 1-2%.The decision whether to start insulin or to add a thiazolidinedione would depend on factors such as patient acceptance, coexisting conditions and access to medicines. At this stage it matters less which drug or ‘pathway’ is used, but more that the patient’s glycaemic target is reached.
Sometimes it is necessary to let patients try triple oral drug therapy. If nothing else, it serves to convince them that insulin is indeed necessary. In this situation, it is important not to delay insulin therapy for more than a few months. A trial of triple therapy for two months should be sufficient to assess whether it is likely to be effective or not.
Human Insulin And Its Analogs
It was expected that the rapid-acting and long-acting analogs, which more closely approximate physiological insulin secretion, would confer important clinical benefits . With respect to type 2 diabetes, the topic of this review, it is important to note that most patients with type 2 diabetes have residual endogenous insulin secretion in the context of insulin resistance. Therefore, the rationale for imitating the insulin secretion pattern of human physiology is less convincing than in type 1 diabetes. Indeed, in patients with type 2 diabetes, the rapid-acting analogs were not found to be superior to regular insulin in reducing A1C levels or rates of overall hypoglycemia . The clinical benefits of the long-acting insulin analogs compared with NPH insulin are limited to a reduction in hypoglycemia .
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How Do I Take And Adjust My Insulin Doses
It is important to learn the different methods of taking insulin and what kinds of insulin can be delivered through each method. There are several ways to take insulin syringe, pen, pump, or inhalation though injection with a syringe is currently the most common for people with type 2 diabetes. There are many apps that can help you calculate your insulin doses.
Your insulin regimen should be tailored to fit your needs and lifestyle. Adjusting your basal insulin dosage and timing will require conversations and frequent follow-up with your healthcare team. When initiating insulin therapy, you may be advised to start with a low dose and increase the dose in small amounts once or twice a week, based on your fasting glucose levels. People with diabetes should aim to spend as much time as possible with glucose levels between 70-180 mg/dl. Insulin may be used alone or in combination with oral glucose-lowering medications, such as metformin, SGLT-2 inhibitors, or GLP-1 agonists.
Tips For Starting Insulin Therapy
Finding out that you need to start taking insulin for your type 2 diabetes may cause you to become concerned. Keeping your blood sugar levels within target range takes a bit of effort, including eating a healthy diet, exercising, and taking your medications and insulin as prescribed.
But while it may sometimes seem like a hassle, insulin can help you properly manage your blood sugar, improve your diabetes management, and delay or prevent long-term complications such as kidney and eye disease.
Here are 10 tips for how to make your transition to using insulin easier.
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Insulin Can Cause Dangerously Low Blood Sugar
Okay this one is possible, but not likely. People with type 2 diabetes tend to be at lower risk of hypoglycemia than those with type 1. A prolonged episode of low blood sugar could cause a loss of consciousness or coma. Still, most people with type 2 can easily recognize the symptoms, which include anxiety, shaky hands, sweating, and an urge to eat. Consuming a bit of sugara few Life Savers, diluted juice, or glucose tabletsquickly reverses the low blood sugar.
You Feel Like Your Life Is Going To Change
In some cases, insulin treatment may be temporary. In others, it is not. Whatever is needed to control your blood glucose should be used. That’s what keeps you healthy.
When your blood glucose is well controlled, you may have more energy, sleep better, and enjoy better moods. You can still do all of your usual activities,eat meals out, and live your life. You may need to check your blood glucose more often, but this will keep you safe, healthy, and informed. You may be surprised that this is a much smaller burden than you thought it would be.
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Throwing Away Your Needles And Lancets
Sharps bins and needle clippers are the safest way of disposing of your insulin needles and your lancets. A needle clipper removes the needle from your insulin pen, and is useful when youre out and about. How you get rid of your sharps bin depends on where you live. Your healthcare team should have information to help you get rid of your bin.
The Advantages Of The Combined Oral Drug And Insulin Regimen
The literature often addresses the question of whether combined oral drug and insulin treatment provides better glycaemic control than insulin alone. This is in a sense a meaningless question because the answer would depend on how much insulin was used. We favour the combined regimen because glycaemic control begins to improve from the day insulin is started. The titration of insulin dosage can be gradual and therefore relatively safe, in an outpatient setting.
The alternative is to stop the oral drugs abruptly. In this scenario, insulin needs to be given at least twice daily and the dose needs to be quickly titrated upward to 70-80 units per day, or glycaemic control may actually deteriorate. This ‘insulin alone’ regimen is obviously possible, but requires more patient contact, making it less user-friendly for both doctors and patients. All too commonly, we have witnessed deterioration in glycaemic control when both oral drugs were stopped and not replaced with sufficient insulin.
In our experience, it is easier to persuade patients to undertake combined oral drugs and insulin treatment. They are often comforted by the knowledge that they only need to take insulin once, in the privacy of their own home and without a great deal of disturbance to their daytime routine. When they are familiar with insulin injections they become accepting of a more intensive insulin regimen, should this be required.
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When Your Doctor Says It’s Time To Start Insulin
When Your Doctor Says It’s Time to Start Insulin. Clin Diabetes 1 July 2004 22 : 151.
If you have type 2 diabetes and your blood glucose isn’t well controlled through diet and oral medicines, your provider may want you to start insulin. You may feel some of the following concerns.
What Other Information Should I Know
Keep all appointments with your doctor and the laboratory. Your blood sugar and glycosylated hemoglobin should be checked regularly to determine your response to human insulin. Your doctor will also tell you how to check your response to human insulin by measuring your blood or urine sugar levels at home. Follow these directions carefully.
You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency.
Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
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Put Your Mind At Ease
Starting to use insulin isnt as challenging as you might think. Methods for taking insulin include pens, syringes, and pumps. Your doctor can help you decide whats best for you and your lifestyle.
You might need to start on long-acting insulin. Your doctor may also recommend mealtime insulin to help manage your blood sugar levels. Its possible that you may switch to a different insulin delivery device. For example, you may start out using an insulin pen and eventually begin to use an insulin pump.
When it comes to your insulin or your insulin delivery system, a one-size-fits-all plan doesnt exist. If your current insulin regimen doesnt work for you, discuss your concerns with your healthcare team.
Can I Take Metformin With Insulin For My Type 2 Diabetes
Metformin is a prescription medication that helps to control blood sugar levels in people with type 2 diabetes. If you have this condition and are 17 or older and take insulin, your doctor may decide to add metformin to your therapy. You’ll probably start on a low dose of metformin while continuing your regular dose of insulin. Your doctor may increase your dose of metformin if necessary until your blood sugar levels are under control. He or your pharmacist can tell you more about how metformin and insulin work together.Continue reading > >
- Is It Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes
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You’ve Heard That Insulin Causes Blindness And Kidney Failure
Nothing could be further from the truth. High blood glucose cause blindness, kidney failure, and other problems, such as nerve damage that can lead to amputations. But eye, kidney, and nerve damage can be delayed or prevented by good control. Insulin will NOT make your diabetes worse, and it is one of the most natural diabetes treatments available.
What Should I Know About Storage And Disposal Of This Medication
Store unopened vials of human insulin, unopened disposable dosing devices and unopened human insulin pens in the refrigerator. Do not freeze human insulin and do not use human insulin that has been frozen. Opened vials of human insulin should be stored in the refrigerator but may also be stored at room temperature, in a cool place that is away from heat and direct sunlight. Store opened human insulin pens and opened dosing devices at room temperature. Check the manufacturer’s information to find out how long you may keep your pen or dosing device after the first use.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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What Is Different About Insulin Lispro
Insulin lispro is a new type of insulin. It starts working sooner than other insulin types. It also reaches peak activity faster and goes away sooner. Insulin lispro helps keep your blood sugar level from going too high after you eat. To keep your blood sugar level steady, your doctor will probably prescribe either a longer-acting insulin or another drug for you to take each day in addition to the insulin lispro.
If you need to mix insulin lispro with a longer-acting insulin, it’s best that you mix insulin lispro only with Humulin U or Humulin N, which are brand names for certain longer-acting insulins. Insulin lispro should always be drawn into the syringe first. This will keep the longer-acting insulin from getting into the insulin lispro bottle.
Types of insulin
Each type of insulin works at a different speed and lasts for a different length of time.
Quick-acting, such as insulin lispro , begins to work very quickly and lasts for 3 to 4 hours.
Short-acting, such as Regular insulin, starts working within 30 minutes and lasts about 5 to 8 hours.
Intermediate-acting, such as NPH or Lente insulin, starts working in 1 to 3 hours and lasts 16 to 24 hours.
Long-acting, such as Ultralente insulin, doesn’t start to work for 4 to 6 hours, but lasts 24 to 28 hours.
NPH and Regular insulin mixture, two types of insulin mixed together in 1 bottle, starts working in 30 minutes and lasts 16 to 24 hours.
Taking Insulin Means Youve Failed
This is a big myth, says Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin.The fact is that type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to make sure your blood sugar is in a healthy range. Eating right and exercise will always be important, but medication needs can vary.A large percentage of people with type 2 diabetes will ultimately need insulin, and we dont see it as a failure, she says.
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So When To Start Insulin In Gestational Diabetes
When insulin is given depends on several factors, such as your individual situation. For instance, if your blood sugar is higher than your target after eating, you may need to take insulin before eating. And if your blood sugar is high after fasting , you may need to take it before bedtime.
But when should you start insulin therapy? There are several different answers.
Be Prepared For Low Blood Sugar
If you inject too much insulin or don’t eat enough, you may experience low blood sugar, a.k.a., hypoglycemia. You may feel sweaty, shaky, confused, fatiguedits an awful feeling, says Dr. Miller. Your instinct may be to reach for the sugar, but do so in a measured way to avoid a blood sugar rollercoaster, Dr. Miller advises. Use the 15-15 rule: Have 15 grams of a carbohydrate . Then, wait 15 minutes and check your glucose levels. If still too low, repeat.
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When To Take Insulin For Type 2 Diabetes
If you have type 2 diabetes, youre probably aware of how difficult it can be to manage. You may struggle keeping your A1c levels in line despite exercising, managing your weight, eating a healthy diet and taking a prescription medication.
Cause of Diabetes
Type 2 diabetes is caused by insulin resistance, stemming usually from genetics, aging, ethnic background, or being overweight. Insulin is a hormone secreted by the pancreas to maintain blood sugar levels. It does this by signaling the liver to store or release sugar into the blood and escorting sugar circulating in blood into cells so that it can be used as energy.
Insulin resistance begins when cells wont allow insulin to unlock their door to let sugar into it. Occasionally it doesnt produce symptoms, but more often than not insulin resistance causes blood sugar levels to rise, leading to prediabetes. Between 15 and 30 percent of prediabetes cases will progress to type 2 diabetes within five years, according to the Centers for Disease Control and Prevention.
Treatments for Type 2 Diabetes
Type 2 diabetes patients are typically prescribed oral medications and lifestyle changes. Generally, insulin is only prescribed after these approaches have become ineffective, as insulin has been linked to weight gain and low blood sugar although some physicians may use it earlier in treatment.
When to Take Insulin for Type 2 Diabetes