Insulin for the management of type 2 diabetes

About 37 million Americans live with some form of diabetes, and 90 to 95% of those who have it have type 2 diabetes.

Estimates vary, but around 1 in 3 people with diabetes need insulin to manage their condition.

The longer you’ve had type 2 diabetes, the more likely you’ll need insulin to control your blood sugar.

In this article, we’ll discuss insulin for treating type 2 diabetes and what you need to know.

Can type 2 diabetes be treated with insulin?

Yes. People with type 2 diabetes use insulin to control their blood sugar levels relatively often.

Not everyone with type 2 diabetes receives insulin right after diagnosis.

However, your doctor will likely suggest it if you have difficulty keeping your blood sugar low with exercise, diet, and oral medications alone.

That’s not a bad thing, and there’s no shame in needing insulin to treat type 2 diabetes!

People with type 2 diabetes can take many different types of insulin. Some people may only require a low dose of insulin, while others may require intensive insulin therapy.

The latter often involves using an insulin pump or taking insulin injections with every meal of the day.

When is the right time for insulin?

This is a very personal decision and is made between you and your doctor.

However, people with type 2 diabetes are usually referred to insulin treatment when diet and exercise alone, or even oral diabetes medications, no longer keep blood sugar levels within a healthy range.

According to the CDC, a healthy blood sugar level for a person with type 2 diabetes is between 80 and 130 mg/dL before a meal and less than 180 mg/dL two hours after a meal.

However, individual blood sugar targets may vary.

Tell your doctor if you start noticing that your blood sugar is rising after meals, is high when you wake up, and that diet, exercise, and oral medications aren’t helping.

Taking insulin not only improves blood sugar levels, but helps prevent diabetes complications and extends life expectancy.

Once your blood sugar is under better control, you’ll feel better and have more energy.

What are the different types of insulin?

There are many brands of insulin, but fewer types.

General types of insulin include:

Long, ultra-long and intermediate-acting insulins

Long-acting insulins like this are essential as the body’s basal insulin.

Even when you’re not eating, your body needs insulin for critical cellular functions. This is because the liver naturally releases glucose.

Even without food, these insulins help the body fight high blood sugar throughout the day.

These types of insulin include:

  • Intermediate-acting NPH (Humulin N, Novolin N, Novolin ReliOn Insulin N, which are more intermediate and last from 4 to 12 hours)
  • Long-acting detemir (Levemir, which is usually given once or twice a day)
  • Long-acting glargine (Lantus and Toujeo, which can be given once or twice a day)
  • Ultra long-acting degludec (Tresiba, administered once a day or even every other day)

These longer-acting insulins can be taken with or without food, usually at any time of the day. The key is to remember to take your injection at the same time each day.

These are usually referred to as “basal” insulins.

Rapid, ultra-rapid and short-acting insulins

Often, short-acting, rapid and ultra-rapid insulins are essential for people on intensive insulin regimens.

Like someone with type 1 diabetes, you’ll take more than one injection a day, often with every meal.

These faster-acting insulins usually need to be given before eating. There are a few exceptions, such as:

  • It is recommended that children dose after eating as they usually do not eat a whole meal.
  • If you are on a low carb ketogenic diet, it is recommended that you take your dose after meals to prevent low blood sugar.

If you’re on a fixed regular insulin regimen, you’ll be giving your dose at very specific times of the day. You will also need to eat according to your insulin regimen.

Newer versions of rapid-acting insulin do the opposite. You give insulin to match the carbs you think you’ll eat.

Talk to your doctor about the right time to take your insulin doses before meals.

Examples of short-acting insulins are Regular (Humulin R, Novolin R, Myxredlin, ReliOn R).

The fast-acting insulins are glulisine (Apidra) and lispro (Humalog and Admelog) and aspart (Novolog), which you take 15-20 minutes before a meal.

There is also Afrezza, which is inhalable and works within about 30 minutes of taking it.

Ultra-rapid-acting insulins are the newest and fastest-acting.

People report being able to eat food within 5 minutes of being injected with these medications, which include aspart (Fiasp) and lispro (Lyumjev).

These are usually referred to as “bolus” insulins.

What are my insulin delivery options?

With the exception of inhaled Afrezza, insulin should be injected subcutaneously (under the skin).

You can either use regular syringes or an insulin pen. Many people find the latter more subtle when dosing in public. In addition, the risk of breaking the insulin vial is reduced.

Rapid-acting insulins taken with an insulin pump can sometimes replace a combination of longer-acting and shorter-acting insulins.

Insulin pumps pump constant microdoses of fast-acting insulin into the body through a thin tube continuously throughout the day and at mealtimes.

There are many different types of insulin pumps available, including Insulet’s Omnipid, which is tubeless and uses Bluetooth technology for all dosing.

Talk to your doctor to find out what type of insulin therapy he recommends for you.

Tips for administering insulin

Your doctor or Certified Diabetes Educator (CDE) will walk you through how to properly inject your insulin with a syringe or insulin pen.

If you use an insulin pump, you will most likely need to undergo full training on insulin dosing.

Ask your doctor what his recommendations are if you decide to use Afrezza inhalation.

These tips may help you when starting insulin injection therapy:

  • Always clean the injection site with isopropyl alcohol before injecting insulin
  • Always use a clean syringe and throw it away after one use
  • Dispose of all sharp objects in a puncture-resistant container, such as a sharps container or an empty milk jug. When full, it can be returned to a medical facility for proper processing and disposal.
  • Insulin is best absorbed in areas where you can pinch about an inch of fat. Areas include the abdomen, hips, thighs, arms and legs.
  • Injection sites should be rotated to avoid the development of scar tissue
  • Insulin is best injected at a 90-degree angle, although talk to your doctor about what angle he recommends for you
  • Always check expiration dates on insulin and do not use expired insulin

What are the disadvantages of insulin therapy?

While insulin therapy is a great option for many people, there are some downsides and side effects to be aware of:

  • Insulin is expensive, especially in the United States, and can cost around $400 a vial without insurance. Some people with diabetes may require as much as one vial per week (usually a vial contains 1000 units).
  • Insulin increases the risk of severe hypoglycemia. Always carry glucose or low sugar snacks with you and ask your doctor for a glucagon prescription for emergency treatment of very low blood sugar.
  • Insulin itself does not cause weight gain. However, many people gain weight once their high blood sugar levels return to normal. It’s healthy!
  • The injections may hurt and you may experience pain, redness or swelling at the injection site


The decision to start insulin therapy can be difficult, but it’s best if the decision is made between you and your doctor.

If you have difficulty controlling your blood sugar with diet, exercise, and existing medications alone, insulin therapy can be a great and effective way to lower your blood sugar and improve your health.

However, insulin therapy can be demanding and requires great attention to detail.

Insulin therapy may increase the risk of dangerously low blood sugar levels, so be aware of this.

In addition, insulin therapy can be expensive and side effects can occur, including slight weight gain and pain, redness and swelling at the injection site.

It’s important for your doctor to be aware of your dosing decisions because your insulin needs can fluctuate and change over time.

Choosing an insulin regimen that supports your lifestyle and health goals can help prevent diabetes complications and improve your quality of life.

#Insulin #management #type #diabetes

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