Finding The Right Time to Start Insulin

08/01/07 Diabetes Medications, Type II Diabetes, Treatment Options, General

There are a number of opinions about when to start insulin therapy. Certainly you will make your decision based on your situation. If you are a type 1 diabetic, you probably started insulin therapy minutes after your diagnosis. If you are a type 2 diabetic with tightly managed blood sugar, you may not need insulin for decades. Regardless of your circumstances, insulin may be the second-best blood sugar management tool. (Lifestyle management is the best.)

When to begin using insulin is a tough decision for people living with type 2 diabetes. Many members of the medical community are conservative about prescribing medications. There are some physicians who wait to introduce insulin until their patients get to a place in their life where ketoacidosis could be a risk. On the other hand, introducing insulin when blood sugar levels are on the low end of the diabetic spectrum can be dangerous. Insulin can contribute to hypoglycemia by removing sugar too aggressively from the bloodstream, thereby starving muscles, brain cells, and other vital body tissues.

According to the American Diabetes Association (ADA) Standards of Medical Care, a person who cannot maintain their A1C level below 7 percent should initiate insulin therapy. Your physician may try a number of medications before trying insulin, but it is not likely he or she will allow you to maintain high blood sugar levels over a long period of time. High blood sugar indicates your pancreas cannot keep up with your insulin demands, and you need to supplement. The ADA also points out that in extreme circumstances, patients may start insulin early on in the disease process. In its document Standards of Medical Care it states:

Early initiation of insulin would be a safer approach for individuals presenting with weight loss, more severe symptoms, and glucose values of 250-300 mg/dL.

When you give yourself an insulin shot you are actually substituting for your pancreas. When medications and lifestyle can no longer control your blood sugar, it's time to let insulin therapy substitute for your pancreas. Insulin may help you live and feel better.

I'm Concerned About the Weight I'll Probably Gain with Insulin

Many people using insulin gain weight. We at My Diabetes Information are pro-insulin. We suspect a lot of people start it too late. Nevertheless, the weight gain is a concern because more weight increases the odds of a number of heart-related health risks—risks already associated with diabetes. Furthermore, extra weight causes angst because of the way it makes us look and feel. Those concerns are legitimate.

Medical professionals are also concerned about the health risks associated with additional pounds. Nevertheless, high blood sugar is usually a more serious health risk than extra weight. You should almost always prefer to use insulin—when the time is right—instead of staying thinner. Of course you should discuss this balancing act with your doctor.