Demystifying insulin: types, uses, and common misconceptions
Living with diabetes often means navigating a complex world of information about insulin. Whether you’ve recently been diagnosed or you’re supporting a loved one, understanding insulin is crucial for effective management.
But don’t worry—we’ve got you covered. In this article, we’re breaking down insulin in a way that’s easy to understand: what it is, the different types, how it works, and clearing up some of the most common misconceptions. Ready? Let’s jump in!
What exactly is insulin?
To start with the basics, insulin is a hormone produced by the pancreas. It plays a crucial role in how our bodies use and store energy from the food we eat. You can think of insulin as a key that unlocks the doors of our cells, allowing glucose (sugar) from our bloodstream to enter and provide energy.
For people with diabetes, this process doesn’t work as it should. In type 1 diabetes, the body stops producing insulin altogether. In type 2 diabetes, either the body doesn’t produce enough insulin, or the cells become resistant to it. This is where supplemental insulin comes into play – it steps in to do the job that the body can’t do on its own.
Types of insulin: a range of options
You might be surprised to learn that insulin isn’t just one thing. There’s quite a variety available, each with its own characteristics. Different types work at different speeds and for different durations. Let’s break them down:
Rapid-acting insulin: This type starts working within 15 minutes of injection, peaks in about an hour, and remains effective for 2-4 hours. It’s typically taken just before or after meals to handle the quick rise in blood sugar that follows eating.
Short-acting insulin: A bit slower to take effect, this type begins to work within 30 minutes, peaks in 2-3 hours, and lasts for 3-6 hours. It’s often used before meals and can provide coverage for snacks.
Intermediate-acting insulin: This type starts working 2-4 hours after injection, peaks 4-12 hours later, and can last up to 18 hours. It’s often used to control blood sugar overnight or between meals.
Long-acting insulin: This type works for up to 24 hours or more. It starts to work several hours after injection and doesn’t really have a peak. It provides a steady, baseline level of insulin throughout the day and night.
Ultra-long-acting insulin: The newest addition to the insulin family, this type can last even longer than 24 hours, providing a very steady baseline insulin level with minimal peaks. For example, insulin degludec (Tresiba) can last up to 42 hours.
Mixed insulin: As the name suggests, this is a combination of two different types of insulin in one injection, usually a mix of rapid- or short-acting insulin with intermediate-acting insulin.
Each type has its place in diabetes management, and the right choice depends on individual needs, lifestyle, and how your body responds. It’s rather like choosing the right tool for a job – you want the one that fits your specific situation best.
How insulin is used in diabetes management
Now that we’ve covered the types of insulin, let’s discuss how they’re used in managing diabetes. The goal of insulin therapy is to mimic the body’s natural insulin production as closely as possible. This often involves using a combination of insulin types to cover both background (basal) insulin needs and mealtime (bolus) insulin requirements.
Basal insulin
Basal insulin is the background insulin that your body needs throughout the day and night, regardless of what you eat. It helps control blood sugar levels between meals and overnight. Long-acting or intermediate-acting insulins are typically used for this purpose. Some people might take one injection of long-acting insulin per day, while others might need two.
Bolus insulin
Bolus insulin is the extra insulin you need to cover the rise in blood sugar after eating. Rapid-acting or short-acting insulins are used for this purpose. The amount of bolus insulin needed depends on several factors:
- The number of carbohydrates in the meal
- Your current blood sugar level
- Your target blood sugar level
- Your insulin sensitivity (how much one unit of insulin lowers your blood sugar)
- Any planned physical activity
Insulin regimens
There are several common insulin regimens that your healthcare team might recommend:
- Basal-bolus regimen: This involves taking a long-acting insulin once or twice daily for basal coverage, plus rapid-acting insulin at mealtimes for bolus coverage. This regimen offers flexibility with meal timing and carbohydrate intake.
- Mixed insulin regimen: This uses pre-mixed combinations of intermediate-acting and rapid- or short-acting insulins, usually taken twice daily before breakfast and dinner. While simpler, this regimen is less flexible.
- Insulin pump therapy: An insulin pump delivers rapid-acting insulin continuously for basal coverage, with extra doses at mealtimes for bolus coverage. This method can provide very precise insulin delivery but requires more management.
Common misconceptions about insulin
Despite how common insulin therapy is, there are still many misconceptions surrounding it. Let’s clear up a few:
1. “Insulin is a last resort”
This is perhaps one of the most pervasive myths about insulin therapy. Many people believe that insulin is only used when all other treatments have failed, or that starting insulin means their diabetes has become very severe. In reality, insulin can be an appropriate treatment at various stages of diabetes.
For people with type 1 diabetes, insulin is essential from the time of diagnosis. In type 2 diabetes, starting insulin early can actually help preserve the pancreas’s remaining insulin-producing cells, potentially slowing the progression of the condition.
Insulin should be viewed as just another tool in the diabetes management toolkit, not as a sign of failure or a last-ditch effort.
2. “Insulin causes weight gain”
While it’s true that some people may gain weight when starting insulin therapy, this isn’t an inevitable consequence. The weight gain, when it occurs, is often due to two factors: a) The body is finally able to properly use the calories consumed, rather than excreting glucose in urine. b) Some people may overeat to avoid hypoglycemia, or may feel more freedom to eat as they please once on insulin.
However, with proper diet, exercise, and careful insulin management, weight can be maintained or even lost while on insulin therapy. It’s important to work with your healthcare team to balance insulin dosage with lifestyle factors.
3. “Once you start insulin, you can never stop”
This misconception can make people reluctant to start insulin therapy. While it’s true that people with type 1 diabetes will always need insulin, the situation is different for type 2 diabetes.
For some people with type 2 diabetes, insulin might be a temporary treatment. Significant lifestyle changes, weight loss, or the addition of other medications might allow them to reduce or stop insulin therapy. However, as type 2 diabetes is a progressive condition, many people will eventually need long-term insulin therapy.
4. “Insulin cures diabetes”
Unfortunately, insulin is not a cure for diabetes. It’s a highly effective treatment that helps manage blood sugar levels, but it doesn’t address the underlying causes of diabetes. Insulin replaces or supplements what the body is unable to produce on its own, but it doesn’t restore the body’s ability to produce or use insulin normally.
Research into potential cures for diabetes is ongoing, but for now, insulin remains a treatment, not a cure.
5. “Insulin injections are very painful”
Many people fear starting insulin because they’re worried about painful injections. However, modern insulin needles are very thin and short, causing minimal discomfort. Many people report that fingersticks for blood glucose testing are actually more uncomfortable than insulin injections.
Proper injection technique, rotating injection sites, and using fresh needles can all help minimize any discomfort.
6. “Insulin can cause blindness, amputations, or kidney failure”
This is a dangerous myth that gets cause and effect backwards. Insulin doesn’t cause these complications – uncontrolled high blood sugar does. In fact, insulin helps prevent these complications by keeping blood sugar levels under control.
7. “If you need insulin, you’ve failed at managing your diabetes”
This misconception can lead to feelings of guilt or shame. Needing insulin is not a personal failure. Type 1 diabetes always requires insulin, and the progressive nature of type 2 diabetes means that many people will eventually need insulin despite their best efforts with diet, exercise, and other medications.
8. “You can’t live a normal life on insulin”
While insulin therapy does require some lifestyle adjustments, it doesn’t prevent you from living a full, normal life. Many people with diabetes successfully manage careers, travel, exercise, and participate in a wide range of activities while using insulin.
Modern insulin regimens and delivery methods (like insulin pens and pumps) offer flexibility that allows insulin therapy to be adapted to your lifestyle, not the other way around.
9. “Natural or herbal remedies can replace insulin”
For people who need insulin, there are no natural or herbal remedies that can replace it. While some complementary therapies may help manage blood sugar levels, they should be used alongside, not instead of, prescribed diabetes treatments. Always discuss any complementary treatments with your healthcare team.
The importance of managing blood sugar
Regular blood sugar monitoring is a crucial part of diabetes management. It helps you understand how your body responds to different foods, activities, and insulin doses. Work with your healthcare team to determine how often you should check your blood sugar.
However, managing diabetes is about more than just insulin. It also involves a healthy diet, regular physical activity, and stress management. The CDC recommends that most adults get at least 150 minutes of moderate activity per week, or at least 30 minutes per day most days of the week, along with at least two days per week of strength training exercises.
By understanding insulin and how it works in your body, you’re taking an important step in managing your diabetes effectively. Always work closely with your healthcare team to find the insulin regimen that works best for you.