Know When You Need Insulin

No one likes injections. So if you have type 2 diabetes, the prospect of giving yourself regular insulin injections may seem scary. But recent research shows that if you're having trouble keeping your blood glucose at healthy levels A1c levels less than 7 per cent starting insulin treatment sooner rather than later is the best way to avoid compli-cations from diabetes down the road.

Why Some Type 2s Need Insulin

Insulin is a pancreatic hormone that helps move glucose into cells, where it is used for energy. Unlike people with type 1 diabetes, who are unable to produce their own insulin and require insulin injections to survive, people with type 2 diabetes do produce insulin.

A major problem in type 2 diabetes is that cells are less responsive, or more resistant, to the actions of insulin. The pancreas compensates by producing more insulin, but over time it cannot produce enough to overcome the cells' reduced response. Many oral medications used to treat type 2 diabetes stimulate insulin production or improve the body's response to insulin.

However, as type 2 diabetes progresses - and it always does - oral medications may not be enough to make up for what the pancreas can no longer manage, and insulin injections may be needed.

About 50 per cent of people with type 2 diabetes need insulin in addition to oral medications to control blood glucose levels. Yet in the past, insulin therapy was often delayed. The New England Journal of Medicine has reported that many people with type 2 diabetes are not prescribed insulin until 10 to 15 years after their diagnosis, and often only after complications from the disease have already set in. As experts learn more about how diabetes progresses, this practice of waiting is changing.

"Today, the trend is not to delay insulin treatment but rather to begin it as soon as people have trouble keeping blood glucose under control with diet, exercise, and oral medication," according to Christopher D. Saudek, M.D., Professor of Medicine at Johns Hopkins University School of Medicine and Director of the Johns Hopkins Diabetes Center. "The worst tragedy is when patients don't take care of their diabetes, get complications, and then wish they had taken insulin."

Know When To Switch

Blood glucose levels indicate how well your body is producing and responding to insulin. If you have diabetes, you probably monitor your glucose levels daily with an at home blood glucose meter, and every 3 months or so, your doctor measures your A1c level an average of your overall blood glucose control over several months.

According to the American Diabetes Association, the target A1c level is 7 per cent or less. You are strongly encouraged to ask your physician to check your A1c and to know your result. Your treatment regimen should be adjusted to help you reach the target levels consistently.

Research continues to demonstrate that the closer you can keep your blood glucose to target levels, the less likely you are to develop complications such as nerve damage, vision loss, and kidney failure. In fact, this connection has become so evident that now each treatment step (diet and exercise are always the first) may be given only a few months to work before the next oral medication or, perhaps, insulin therapy is added.

Overcoming Obstacles

Many people are reluctant to begin insulin therapy, afraid that the need for insulin means they failed to man-age their disease on their own. It is important to remember, though, that type 2 diabetes is a controllable but progressive condition. Even if initial treatments are successful in control-ling blood glucose levels, eventually most people will need additional therapies.

The most important thing you can do to stay healthy is to keep your blood glucose levels in check. If other medications aren't working, insulin can be a helpful tool in your quest to manage your diabetes.

Other obstacles include a fear of side effects such as hypoglycemia or weight gain, or pain caused by the needles. But these hurdles are manageable. For instance, hypoglycaemia low blood sugar that can result in dizziness and confusion-can be avoided by taking the correct amount of insulin, eating meals at fairly regular times, and having a snack before exercising. Dr. Saudek adds, "People have all sorts of understandable concerns. They worry about the injection, or whether they will have to lead their lives differently, whether they have been a personal failure, or even whether the insulin will cause com-plications," he says. "But in the end, almost everyone learns to take insulin very well, and they feel better and are healthier as a result,"

Bottom-Line Advice

People with type 2 diabetes need to be aggressive about managing their blood glucose levels. This means first improving diet and increasing exer-cise levels; if needed, oral medications should be added. Know your A1c level; shoot for under 7 per cent. You might need insulin treatment soon after diagnosis or many years later. But if oral medication is not entirely effective at tightly controlling your glucose levels, insulin will be.

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