Dose size | Insulin addiction | Meal schedule | Soreness of injections | Insulin administration difficulties | Weight gain | Insulin therapy complications
In type 2 diabetes, insulin is one of the glucose-lowering drugs used to treat the disease and keep blood sugar at a safe level. But it so happened that the addition of insulin to the treatment causes a lot of unpleasant emotions and is difficult for many patients. This is largely due to misconceptions about insulin that are ingrained in society.
In reality, insulin therapy for type 2 diabetes has only two drawbacks: it requires teaching the patient to properly administer the drug and often has a higher cost than oral medications.
Below are the “myths” and the reality.
“Large doses of insulin are worse than small doses.”
This is a fairly common (both among patients and among doctors) myth, due to which a very large number of patients with both types of diabetes receive insufficient doses of insulin, which leads to chronic, sometimes long-term, diabetes decompensation.
In reality insulin dosage is determined by the level of sugar during use.
If you need to increase the daily dose of insulin to achieve normal sugar, this should be done. The alternative is to live with a low dose of insulin but high sugar levels, which naturally damages the body and leads to diabetes complications.
True, in many situations it is possible to enhance the effect of already used insulin. When overweight with type 2 diabetes, this allows for strict adherence to diet and weight loss. In both types of diabetes, the effect of insulin can be weakened by:
- Incorrect insulin injection technique
- Improper nutrition, fear of hypoglycemia
- Chronic inflammatory processes urinary tract infection. dental diseases, etc.).
If these problems are excluded, the diet for type 2 diabetes is followed correctly — then the dose of insulin is calculated so as to provide blood sugar before meals and 2 hours after meals at the level of recommended safe values. The daily dose required for this varies (both with type 1 and type 2 diabetes) in different patients over a wide range: from 0.5-1 units per 1 kg of patient weight (so-called average doses) to large ones — reaching 1.5 and even 2 units per 1 kg of body weight (so-called high doses).
By itself, the ratio of the daily amount of insulin to the patient’s weight (as well as the dose per 1 kg of ideal body weight, etc.) is by no means a criterion for choosing the correct dose. This indicator is only used to reflect which doses of insulin are required for a given patient — low, medium or high.
The daily dose of insulin is not limited. If you need to increase the daily dose of insulin to achieve normal sugar, this should be done.
According to the current recommendations of the American Diabetes Association and the European Association for the Study of Diabetes, the daily dose of insulin is not limited.
A single dose of short-acting insulin is usually 6-10 units, the maximum is 14-16 units (due to the peculiarities of subcutaneous absorption of higher doses), but if necessary, additional administration of 4-6 units is possible 2 hours after meals.
If a patient with type 2 diabetes mellitus is prescribed high doses of insulin to achieve compensation, very often after a few days (weeks) the effect of insulin increases (at normal sugar levels, insulin acts more strongly than at high levels). With the onset of such a “breakthrough” in treatment, the dose of insulin is reduced.
“Insulin is addictive, termination is life threatening”
Diabetes mellitus is a chronic disease (one of many), and beta-cell failure requires lifelong treatment. Pills and diet are also prescribed for life. With sufficient beta-cell function, temporary insulin therapy (during surgery or pregnancy) can be successfully discontinued. With type 2 diabetes, withdrawal of insulin is not as dangerous as with type 1 diabetes, but carbohydrate metabolism returns to the state of decompensation that was before the start of insulin therapy.
“The patient should inject insulin and take food on an hourly basis.”
The mealtime can be shifted within 1-2 hours on mixed insulin therapy (short and extended insulin are mixed in one solution) and within practically unlimited limits — with separate administration of short and extended insulin. The dietary requirements of a patient receiving insulin are not stricter than those of a patient receiving most antihyperglycemic tablets.
“Insulin delivery is painful”
Modern, thin needles make the injection virtually painless. For patients with a fear of injections (akin to the fear of blood) — adults and children — there are needleless injectors and special injection devices in which a needle is hidden (Pen-mate).
“It is difficult to administer insulin”
Modern means of administering insulin (especially syringe pens) allow you to inject on the road, at a party, at work, etc. The opened insulin vial (or pen cartridge) is stored at room temperature. The injection does not require the treatment of the skin with alcohol, it can even be carried out through clothing. With a bit of training, anyone can master insulin injections, which are technically easier than other injections.
“Insulin causes weight gain”
In the absence of an obvious overdose, insulin therapy does not cause weight gain significantly more than that to which the appetite regulation system is “tuned”. Insulin therapy often begins after a fairly long period of diabetes mellitus decompensation. High sugar levels cause weight loss by losing some of the food intake in the form of urine glucose. Normalizing sugar (using insulin or pills) stops this loss of nutrients, all the food consumed by the body is used by the body, and the weight becomes what it should be with the available daily calorie intake and level of physical activity.
In a large and long-term study, weight gain over 10 years averaged 6.2 kg in patients with type 2 diabetes on insulin, 3.5-5 kg - on “classic” tablets (sulfonylurea derivatives) and even 1.7 kg — on a diet (remember the tendency to gradually gain weight with age — mainly due to a decrease in physical activity).
It should be remembered that the harm from high blood sugar is so significant that normal sugar with excess weight and the use of insulin is much safer than high sugar with normal weight.
“Insulin therapy makes the disease more severe”
The severity of the disease is determined by the presence of complications. On average, patients on insulin therapy have diabetes mellitus longer, and have more complications (especially with too long a period without insulin), but more severe diabetes is not a consequence, but a cause of insulin therapy.
If the patient refuses insulin therapy, an experienced endocrinologist will ask him about the reasons for this. Discussing the reasons helps the endocrinologist propose a solution.