Diabetes Type 2

Coping with insulin

Although many people diagnosed with type 2 diabetes will be prescribed tablets (e.g. metformin) eventually many people will be transferred to insulin. Insulin cannot cure diabetes - there is still no cure for diabetes - but it can slow the progress of the disease and make it easier for some people to control their blood glucose. Those who had changed to insulin from tablets said that they felt much better because insulin kept their blood glucose more stable. 

Most people we interviewed who were on insulin had had diabetes for five or more years and most of them had started with  oral medication such as metformin (see 'Controlling diabetes with metformin and other medications'). Only a few people had been prescribed insulin directly after being diagnosed. The kind of insulin and also the dosage varied from person to person, according to their blood glucose level and their state of health; few people could recall the name of the insulin they were taking. 

There are seven main types of insulin:

  • Rapid-acting analogues - injected just before, with or after food and only last long enough for the meal at which they are taken.
  • Long-acting analogues - injected once a day to provide background insulin.
  • Very long-acting analogues – provides background insulin for 42 hours (3 days) and are normally used for people unable to inject themselves and are given by a healthcare professional.
  • Short –acting insulins- injected 15-30 minutes before a meal to cover the rise in blood glucose after eating. They work for 2-6 hours but can last up to eight hours.
  • Medium - and long- acting insulins – are taken twice a day to provide background insulin or in combination with short-acting insulins or rapid- acting analogues.
  • Mixed insulin – a combination of medium- and short-acting insulin.
  • Mixed analogue – a combination of medium-acting insulin and rapid- acting analogue.      

Originally all insulins came from animal sources and were known as porcine (pork) or bovine (beef). Many of these remain available and are very inexpensive. Then it became possible to synthetically manufacture insulins that were exactly the same as the insulin we normally produce in our own pancreas: human insulins. More recently insulin manufacturers have produced insulins closely similar to the human type but slightly modified to have certain alleged benefits: the so-called "analogue" insulins and these are designed to work at different speeds and said to have a more predictable absorption rate than human or animal insulins. Most people tend to use human insulin or insulin analogues when first diagnosed but a small number of people still use animal insulins as they find it works better for them as they found they lost their hypo warning symptoms when using human or analogue insulins.

Some experienced insulin users had developed routines that worked for them and preferred to stick to their own tried and tested methods of coping. Others valued deciding for themselves whether to raise the insulin dosage depending on what they were planning to do or eat. The 'Dosage Adjustment For Normal Eating' or DAFNE routine was thought by several people we interviewed to be a good way for very active people to manage their insulin although this system is normally for Type 1 diabetics only. This is because those with Type 2 diabetes do produce some insulin which makes carbohydrate/insulin ratios fluctuate

There are several other education courses that are recommend for people with Type 2 diabetes:

  • Diabetes Education for Self-Management for Ongoing and Newly Diagnosed (DESMOND) for people with Type 2 diabetes
  • The X-PERT Diabetes Programme for people with Type 2 diabetes and the X-PERT Insulin Programme for people with Type 1 or Type 2 diabetes

Several people said that being 'insulin-dependent' had given them an illness identity which made them feel they were defined by their diabetes. Others who were not on insulin felt that it marked a point of no return, and that they intended to resist it for as long as possible. Others not yet on insulin were simply worried by the thought of it. 

People also talked about the practical difficulties of taking insulin during their everyday lives; how they managed their injections when they went out for meals with friends and how they had to use different parts of the body to avoid getting sore patches of skin. 

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Several people stressed to the importance of keeping insulin cool when travelling. Insulin needs to be kept at temperatures lower than 25°C/77°F, ideally between 2 and 6°C/36 and 43°F.

Some of the people interviewed said they had not been told how they should dispose of their used needles or 'sharps'. Several people noted how important it was to keep injection sites clean and also to shake the insulin container before the injection.

Although the pros and cons of traditional forms of insulin made from animals as opposed to newer 'human' insulins manufactured synthetically have been hotly debated for years, no one we met expressed an opinion on this subject. 

For links to more information on coping with insulin see our resources section. See also 'Managing hypos'.
 

Last reviewed March 2016.

Last updated March 2016.

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