Table 3.

Questions about starting insulin: information on the myths, misconceptions and clinical realities about insulin

Here are some of the questions and fears people with diabetes often have when changing their medicines:

“Isn’t oral (pill) medication an easier way of treating my diabetes?”

Pills are simple and easy to swallow, but they rely on the insulin in your body to work. As your diabetes progresses and your body makes less insulin, pills may not work as well to keep your blood sugar at your target level [42, 43]

“After my grandmother went on insulin, she suffered from all sorts of complications and health problems like amputations. I am afraid of the same thing happening to me”

Although the problems your grandmother faced might have started around the time she started insulin, these problems were not caused by insulin. They were caused by the diabetes [44]. These problems are known to be related to high blood sugar levels, and not insulin. It is very possible that if your grandmother had started using insulin sooner, she might have delayed or prevented these serious complications of diabetes by having better control of her blood sugar over the years [25]. We now know that starting insulin earlier in the course of diabetes helps to delay or prevent the serious complications and health problems that can be caused by long periods with high blood sugar levels [42, 43]

“I don’t think I need insulin because I’m not really that sick. Can’t I put it off until the diabetes gets worse?”

Although many people think of insulin as a “treatment of last resort,” that really is not true. Even though you don’t feel sick or have complications, your high blood sugar levels are taking a toll on your body [42]. Starting insulin does not mean that your diabetes is worse. It is just the opposite—insulin can help you stay healthier by keeping your blood sugar level on target [42, 43]

“I hear that insulin causes weight gain? Do diabetes pills also cause weight gain?”

It is true that some people who begin taking insulin do gain weight [44]. Insulin helps you to use food more efficiently, so even if you eat the same amount as before, you may gain some weight [45]—somewhere between 4 and 9 pounds [4]. If this is a concern for you, talk with your doctor about it and ask for a referral to an educator or dietitian. You can help prevent the weight gain by becoming more active or making some changes in your eating habits [42, 43]. While some of the pills used to treat diabetes can make you gain weight, others (such as metformin) do not usually affect your weight

“Does needing to go on insulin mean that I’ve failed to manage my diabetes?”

Needing insulin does not mean that you have failed or that you have not tried hard enough [46]. Over time, your pancreas makes less insulin and your body needs more help to keep your blood sugar on target [42, 43]. This will likely happen, no matter what steps you’ve taken, or how hard you’ve tried to manage your diabetes [44]. So the insulin you take is just replacing the insulin that your body is no longer making [42, 43]

“Doesn’t insulin cause the pancreas to stop working, which means I’ll need to keep taking more and more insulin over time?”

No, this is not true. Insulin helps by adding to the natural insulin that your body makes [42, 43]. It doesn’t damage or slow down the pancreas, where your own insulin is made [10, 47]. In some cases it may even give your pancreas a rest from the stress of high blood sugars

“Why do I have to adjust the dose of insulin I am taking?”

It is likely that it will take some time to find the best dose of insulin for you, and your dose will likely change over time. This does not mean your diabetes is worse, it just means you need more or less insulin to keep your blood sugar level on target [42, 43]. Your dose may also be adjusted depending on what you eat, how active you are and how much you weigh [42, 43]. Your blood sugar monitoring levels will help you and your health care provider to decide how to adjust your dose

“Doesn’t insulin cause low blood sugar (hypoglycemia)?”

It is true that insulin is more likely to cause a low blood sugar reaction than diabetes pills [42, 43]. However, with modern, longer-acting insulins (insulins that work slowly and for a longer period of time in your body), low blood sugar or “hypos” are less likely to happen than with the fast-acting insulins—but it can still happen [42, 43]. This is one of the reasons insulin dose is adjusted. When you learn how to take insulin, you will also learn how to prevent low blood sugar, how to know when it is happening, and what to do if it happens [42, 43]

“If I choose to be on insulin, how much will it affect my daily life?”

Using insulin does mean that you will have to give yourself shots, but they can be done in privacy, and most people find that it is easy to do once they learn how to do it. It also means you may need to check your blood sugar more often than you are doing now [42, 43]. Many studies have shown that when insulin is started, people find that they have more energy, have more flexibility in planning their day-to-day lives and feel better about themselves due to the improvement in blood sugar control [25, 44]

“If I give myself a shot, won’t it be painful?”

Most people are surprised at how little an insulin shot hurts [25, 44]. Most people find the pain level from an insulin shot to be less than that of a finger-stick for routine blood sugar monitoring [44]