FAQ's On Insulin
Patients and their families often have a large number of queries concerning
insulin. We address the most common of these questions -
1. Do patients of type 2 diabetes need to learn and know about insulin?
Yes, they most definitely do. Type 2 diabetes is a disease of inadequate insulin
production and inadequate insulin action. In these patients, the production
of insulin tends to decline gradually over time. And frequently, after ten or
fifteen years of living with type 2 diabetes, patients of this disorder need
to take insulin injections as well.
2. Under what conditions must insulin be given to type 2 diabetics?
The conditions under which insulin is given to type 2 diabetics fall under two
categories
1. If the sugar is very, very high - either at the time of diagnosis,
or due to another illness. During such illnesses, insulin might not be secreted.
Such a high sugar effect - we call it glucose toxicity - is difficult to control
by oral medication. The patient is required to take insulin in such cases.
2. The other instance - a more permanent situation - is that in time, beta cell
numbers decline in type 2 diabetes as well. That's the natural history of the
disease, though the time it takes cannot be predicted. In such cases, when an
absolute insufficiency of insulin occurs, insulin therapy becomes necessary.
Again, type 2 diabetes, by definition, is insulin resistance and a relative
insufficiency of insulin secretory capacity. The fact remains that the patient
is insulin resistant, and thus needs a larger amount of insulin. Even if a patient
is producing more than the normal amount of insulin, he or she will need external
help. Early on in the disorder, the pills work. They either reduce insulin resistance,
or aid the pancreas in the production of more insulin. But pills do not work
when the beta cells decline in number, and that's when insulin is needed.
3. Can oral medication and the insulin be used together?
Absolutely. As the beta cell number in your body declines, you may need a little
help from externally injected insulin, but you still might need oral medicines
to help the pancreas make a little more insulin on its own, in a more natural
pattern. In addition, decreasing insulin secretory capacity does not mean an
end to insulin resistance, so it is necessary for you to keep taking pills that
reduce insulin resistance.
4. Is it necessary for a type 2 diabetic to stay on insulin treatment once
he or she starts on it?
Most type 2 diabetics need to stay on insulin treatment once they start with
it.
There are, however, some instances - like the occurrence of another illness
- that might raise blood sugar levels alarmingly, where the use of insulin may
be temporary. Moreover, insulin treatment is basically used to match the needs
brought on by insulin resistance, and to normalize the sugars. To achieve that,
one of two things need to be done - either the insulin in the body must be increased,
or insulin resistance must be reduced. But let's say the patient loses ten or
fifteen kilos. What happens now is that insulin resistance drops so that, at
some point, the patient's own pancreas regains the ability to keep up with the
insulin production. In such cases, the patient could be taken off insulin. Weight
loss does help you come off insulin, if for a while. Five to ten years later,
you might have to restart on insulin, but for that period of time you could
be stay off it comfortably.
5. What are the side effects of taking insulin?
Insulin does cause allergies and other minor discomforts in patient, but it
has two major side effects -
1. Hypoglycemia
If the body is given more insulin than it needs, blood sugar levels drop. This
could also occur due to excessive exercise/activity, or if the patient hasn't
eaten well. Now most low sugar reactions are relatively minor and can cause
some discomfort. But on rare occasions, particularly with type 1 diabetes, hypoglycemia
or low blood sugar levels can cause mental imbalance, induce a state of coma,
or can even result in death. So it is really important that you maintain a proper
balance between the insulin, the food and the activity. These are the three
main factors: insulin, activity and food. And they need to be balanced.
2. Weight Gain
Though insulin, by itself, does not contain any calories, weight gain is one
of the commonest side effects of insulin treatment. We have seen how blood sugar
levels can drop after the intake of insulin. When the sugar is low, the patient
naturally reaches out for more food. And if this is happens fairly frequently,
it stimulates the patient's appetite, and thus he or she gains weight. An improperly
balanced insulin program leads to an increase in weight. A program that's physiologically
balanced, with multiple injections even for type 2 diabetics, definitely minimizes
weight gain.
6. How do you manage reactions to insulin?
The dose of insulin that you are taking needs to be reduced until you figure
out what's going on. You may need to do this in conjunction with your healthcare
team. When you have an insulin reaction, the subsequent blood sugar shoots up
due to a rebound phenomenon. Sugar pours back into the bloodstream. A lot of
patients get confused - they see the high sugars and miss the lows, chase it
with more insulin - and only make the situation worse. The first thing to do
is to reduce the dose of insulin and to let the dust settle. Then, take a good
look at what's going on. Are you getting too much insulin in the morning and
delaying your supper, having it come at you later in the day, or is it the question
of balance between activity, eating and insulin that may be out of whack...the
answer to this question will help you handle your reactions better.
7. How do I handle frequent
Insulin reactions?
Often, frequent reactions happen when the insulin treatment design just doesn't
match the patient's daily schedule and eating habits. This is reason enough
to move on to a more complex physiological program - going from two shots to
three or four shots - something that gives the patient less insulin in each
individual shot, and maintains a better balance and distribution of the insulin,
so at any given time you don't have as much insulin peaking and coming at you
at once. This often stops the problem and smoothes the patterns out, but it
has to be done carefully and over a period of time.
8. What are the most common problems in the insulin regimes of patients?
One of the most common problems seen in patients' insulin regimens is the use
of NPH or Lente, or other intermediate-acting insulins just before dinner. This
leads to low sugars frequently in the middle of the night because that's when
that insulin starts to peak. People come in to clinics complaining of low sugars
frequently at two, three, four o'clock in the morning. A change in routine,
after consulting with your doctor, will certainly help alleviate this problem.
9. Can I take more than two doses of insulin a day?
There's a lot of hesitation among patients about taking more than two shots
of insulin a day. Three shots a day might crowd the day. Moreover, they may
still need the faster-acting insulin at dinner. But patients who use three shots
often sleep better, get through the night better and don't gain as much weight.
They experience lesser lows, and feel more rested at night. Once they get a
smoother pattern of sleep and rest overnight, most people stick with the extra
shot. It's worth it.
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