Robert Gabbay, MD, PhD, the chief medical officer of Joslin Diabetes Center, answers a common question:
Q. How can insulin help manage diabetes, and how should I take it?
A. The goal in taking insulin is to control blood sugar. When blood sugar is well controlled, you can prevent diabetes complications such as eye disease, kidney disease, amputations, heart disease, and stroke. People with type 1 diabetes need insulin to stay alive. Those with type 2 diabetes can eventually lose the ability to make enough insulin and will then need it to control blood sugar.
Which type of insulin you take -- short-acting or long-acting -- depends on your needs. If you have type 2 diabetes and your body still makes some insulin, you may only have to take long-acting insulin. If you have type 1 diabetes, or you have type 2 diabetes but you’ve lost more of the ability to make insulin, you’ll need short-acting insulin to cover your needs when you eat, and long-acting insulin for overnight and between meals.
Your insulin dose is initially based on your weight, but that’s just the starting point. After that, the dose is based on blood sugar measurements you take at home. Those measurements help you determine whether you’re taking the right amount of insulin so you can adjust the dose accordingly. To prevent blood sugar from swinging too high or low, measure it often. Eventually, you’ll learn how to adjust your insulin dose based on your blood sugar level, the number of carbohydrates you eat, and your exercise routine.
You can inject insulin with a syringe, pen, or pump, inhale it, or use a needle-free jet injector that gives you insulin under the skin. Most people use either the pen or needle and syringe, because these are least expensive and insurance often covers the cost. Inhaled insulin tends to be reserved for people who are less comfortable with the idea of injections, particularly those with type 2 diabetes. If you check your blood sugar often, the pump allows you to fine-tune the dose if you need to and are comfortable with the technology.
To store unopened insulin, put several vials or pens in the refrigerator until the expiration date. Remove them one at a time when you’re ready to inject. Once opened, you can store insulin at room temperature for about a month.
It’s not unusual for people with diabetes to be concerned about starting on insulin, but you don’t need to be afraid. Insulin injections hurt less than taking blood sugar level readings. The needles are now smaller and less uncomfortable. Once you get over your reservations, you should find that insulin helps you manage diabetes much better.
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