Type 2 Diabetes and Insulin

When dietary changes, exercise, and medications don't work

 

People with type 2 diabetes do not always have to take insulin right away; that is more common in people with type 1 diabetes. The longer someone has type 2 diabetes, the more likely they will require insulin. 
 
Just as in type 1 diabetes, insulin is a way to control your blood glucose level. With type 2 diabetes, though, dietary changes, increasing physical activity, and some oral medications are usually enough to bring your blood glucose to a normal level. To learn about how the hormone insulin works, we have an article that explains the role of insulin.
 
There are several reasons people with type 2 diabetes may want to use insulin:
  • It can quickly bring your blood glucose level down to a healthier range. If your  blood glucose level is excessively high when you are diagnosed with type 2 diabetes, the doctor may have you use insulin to lower your blood glucose level—in a way that’s much faster than diet and exercise.

    Insulin will give your body a respite; it (and especially the beta cells that produce insulin) has been working overtime to try to bring down your blood glucose level.

    In this scenario, you’d also watch what you eat and exercise, but having your blood glucose under better control may make it easier to adjust to those lifestyle changes.
  • It has fewer side effects than some of the medications: Insulin is a synthetic version of a hormone our bodies produce. Therefore, it interacts with your body in a more natural way than medications do, leading to fewer side effects. The one side effect is hypoglycemia.
  • It can be cheaper. Diabetes medications can be expensive, although there is an array of options that try to cater to people of all economic levels. However, insulin is generally cheaper than medications (on a monthly basis), especially if the doctor wants you to take multiple medications.
 
If you do decide to use insulin to help control your type 2 diabetes, you should learn all you can about it. Talk to your doctor and diabetes treatment team. They can walk you through the basics of insulin dosing, answer any questions you have, and help you figure out how to balance food, exercise, and insulin as you take care of your body.
 
Read on to learn more about the basics of insulin treatment. You can also visit our Patients’ Guide to Insulin for more details.
 
Types of Insulin
There are several types of insulin you can take. Each type serves a different purpose, and you might need to take a combination of the following:
  • Rapid-acting: This type of insulin takes effect in 15 minutes or less, and you take it before a meal. In someone without type 2 diabetes, the body releases the right amount of insulin when they eat; it’s the insulin that should help them process and use the carbohydrates in the food. That release of insulin at mealtime is called the bolus secretion. Rapid-acting insulin imitates the bolus secretion.
  • Regular or Short-acting: Regular (also called short-acting) insulin takes effect within 30 minutes. It’s also taken before a meal, but its effect lasts longer than rapid-acting insulin. Regular or short-acting insulin also imitates the bolus secretion.
  • Intermediate-acting: This type of insulin lasts for 10-16 hours. It’s generally taken twice a day, and it’s used to imitate basal secretion. The basal secretion is the small amount of insulin that should always in your blood.
  • Long-acting: Similar to intermediate-acting insulin, long-acting insulin replicates the basal secretion. Long-acting insulin lasts for 20-24 hours, so you only need to take it once a day; you have to take intermediate-acting insulin twice a day.
  • Pre-mixed: A pre-mixed insulin combines two other types of insulin—a rapid-acting and an intermediate-acting insulin, for example. This makes sure that you have insulin to cover the bolus and basal secretions.

How Much Insulin Should You Take?
Your doctor will calculate the correct dosage for you the first time you take insulin, and he or she will work with you to figure out the best insulin plan. He or she will take into consideration your weight, age, diet, overall health, and treatment goals.
 
After you have the plan, it is recommended to work with your healthcare professional or a certified diabetes educator (CDE) to teach you how to adjust the insulin doses, based on how your blood glucose level responds. Say, for example, that you take a certain dose before breakfast. If your blood glucose is too high afterwards, you know that you should take more insulin the next time. You should seek your diabetes treatment team’s advice before changing your dose.
 
As imprecise as it sounds, figuring out the best insulin dose is a matter of trial and error. You should work closely with your diabetes treatment team to monitor how well your insulin is working, and to adjust it as necessary.
 
Where Should You Inject the Insulin?
There are four main areas to inject insulin:
  • Abdomen
  • Thighs
  • Hips/Buttocks
  • Backs of arms
 A few notes about insulin injection sites:
  • Insulin injected into the abdomen is absorbed (and therefore put to work) the most quickly.
  • Using the same insulin injection site over and over is not a good idea. Eventually, insulin injected at that over-used site won’t be absorbed as quickly. You should rotate sites.
  • How far in you inject the insulin also affects how quickly it’s absorbed.
Your doctor and diabetes treatment team will walk you through where to inject insulin and other important details.
 
Newer, Easier Ways to Inject Insulin
You have many options for “insulin delivery,” as it’s called. Companies and researchers are always looking for better, less painful, and more convenient ways to get insulin into the body.
 
For a long time, most people used syringes and needles. Now, many people are using pens.  They can be more expensive than vials and syringes, though.
 
Another option for insulin delivery is an insulin pump. This is a device that gives your body insulin, just like the pancreas does, and it does it constantly. The pump is worn externally, but there’s a tube and needle that send insulin under the skin. An insulin pump requires more training to learn how to use it.
 
A Final Note about Insulin
Often after having type 2 diabetes for a long time, oral medications may not work as well as they used to. If that happens, insulin is a way to keep blood glucose (blood sugar) levels in control. In combination with a healthy meal plan, increased physical activity, and medications, insulin can control your blood glucose level and keep it in a healthy range.
 

 

View Sources
  • American Diabetes Association.  Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32:S13-61.
  • Becker G. Type 2 Diabetes: An Essential Guide for the newly Diagnosed. 2nd ed. New York, NY: Marlowe & Company; 2007.
  • McCulloch D. Patient information: Diabetes type 2: Overview. UpToDate Web site. January 30, 2009. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~n0K0MIfI1iZs.&selectedTitle=5~150&source=search_result. Accessed April 20, 2009.
  • McCulloch D. Patient information: Diabetes mellitus type 2: Overview. UpToDate Web site. December 4, 2008. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~X0jjLnBn4._ko&selectedTitle=4~150&source=search_result. Accessed April 20, 2009.