Insulin Use in Type 2 Diabetes: Fears and Misconceptions

By Corinna Santa Ana

3 min read

As a person with type 2 diabetes who uses insulin as part of my diabetes care routine, I have to say I was shocked at how other people have reacted to this fact.

People have strong opinions

When I first started using insulin and people found out, it seemed everyone had an opinion about it. The responses I got included everything from judgment to pity. Somehow my diabetes care was no longer just between my healthcare provider and me. It was subject to other people's opinions.

I understand insulin is closely associated with type 1 diabetes, not type 2. I know that some people are squeamish around syringes. But most of the things I heard were based on misconceptions or fears, not facts. None of it seemed really relevant to me or my health.

Using insulin is not a sign of failure

Insulin is a hormone that regulates glucose levels in the blood. It's what makes it possible for our bodies to convert the food we eat and drink into energy we can use. This energy keeps our organs, and bodily systems working and makes it possible for us to do everything from thinking a thought to walking a mile.

That's it.

A common misconception about type 2 diabetes

Somehow there's this misconception that if you have type 2 diabetes and your body can't produce enough insulin anymore, it's because of something you did wrong. Maybe you ate too much sugar. Perhaps you didn't exercise enough. It must be because you didn't care for yourself and your pancreas. And now you have to suffer the consequences.

This line of thought completely misses the point that diabetes (whatever type you have) is a degenerative disease. And while early on, it might be possible to bring type 2 diabetes into remission, for the vast number of people affected, this won't happen. Even with consistent, tight management of glucose levels, there is no guarantee that some other factor (genetic or environmental, for instance) won't drive progression.

Insulin is a hormone. Without it, a person will waste away and eventually die.

Shots don't have to be painful

The second most popular comment I heard was, "Doesn't taking an insulin shot hurt?" People usually followed up this comment with something like "I hate needles" or "I couldn't give myself a shot."

Our first experience with a syringe is often as a child receiving a vaccination. It's an emotionally charged situation. One of our parents is probably doing their best to hold us still while praying for it to be over quickly. A strange person comes at us with an unfamiliar object. There's a poke. And then there's a release of emotion. Sometimes it's a deep breath. More often, it's tears and loud sobs - not a great introduction to an essential healthcare instrument.

Negative associations in the media

More negative associations with syringes get reinforced in popular culture, especially TV and movies. In medical dramas, a needle is plunged into the patient when they go into some kind of distress. In murder mysteries, a deadly poison is administered using a syringe. In police procedurals, dirty needles on the ground signal illicit drug use, and worse. Syringes are often shown to look bigger and more imposing than they really are, providing a visual shortcut in telling the story.

With all these negative associations, no wonder syringes give so many people heebie-jeebies.

Learning to self-administer shots

Giving yourself a shot is a skill that needs to be learned. I don't know anyone who was completely comfortable the first time they did it. It takes time. It takes patience. Then, it can be done by most of us.

These days some methods can be used to make taking a shot easier and more comfortable. Needles are available in various sizes (lengths) and gauges (widths), making the poke more precise and comfortable. You can use insulin pens to make it easier to get the dosing right. And insulin pumps with their infusion sets require fewer insertions overall.

These fears and misconceptions cause real harm

These fears and misconceptions might seem small and unimportant to someone who doesn't need to use an injectable. You might ask, "What's the harm?" The harm is that they keep people from getting the diabetes care they need.

Feeling ashamed of needing insulin shots stops some people from adding insulin to their diabetes care routine. Being fearful of syringes can have the same effect. Instead of using the most effective tools and medications available to manage their glucose levels, they resist change — a change that could lead to better health and quality of life.

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richard-morris Member
It's an important message that injecting Insulin is lifesaving if you can't make enough, and the actual mechanism of injecting will become easy and the last thing to worry about with respect to insulin dependent diabetes. A more important concern will be how much do I need to inject right now. That excellent point is diluted by some claims that are not correct. The first is that Insulin isn't only needed to allow you to convert fuel into energy, it also functions to prevent you converting fuel into energy. Let me explain that apparent paradox. We have 3 fuels sources, glucose (from carbohydrates), amino acids (from protein) and fatty acids (from fat). Only 1 of them requires insulin to get into cells to be burned for energy. Insulin signaling enables your cells to take up glucose, while shutting down the transport of fatty acids to be burned to make energy. How much insulin you need depends on how many carbohydrates are in your diet. There are people living happily energetically sufficient on ultra low carb diets who run mostly on fatty acids and need very little insulin. There also are people who eat diets rich in carbohydrates who have to inject a lot. The difference between giving yourself too little, too much, or just the right amount in the second case is subject to the law of large numbers having larger errors and much more difficult to achieve the "goldilocks" amount. The second incorrect claim is that diabetes is almost exclusively a degenerative disease, and that some few who catch it early may be able to reverse some of the disease the vast number won't. Roy Taylors and Mike Leans Direct trial in the UK was able to show with an ultra low calorie (also ultra low carbohydrate/low fat/moderate protein) soy based shake that remission was possible in 17.8% of type 2 diabetics with an average time since diagnosis of 1 year. Sarah Hallberg and Stephen Phinney's VirtaHealth trial of an ad libitum (eat as much as you want) high fat/ultra low carb/moderate protein diet in type 2 diabetics with an average time since diagnosis of 8.4 years that they saw remission in 53% of subjects, and a reduction in injected insulin in 94% of subjects who were insulin dependent. So I'd add to your important message that "if you need insulin, injecting it is a lifesaver, and no big drama" the message ",and there may be some things you can do in your diet that can reduce the amount you need, and even reverse the progress of the disease. And it may not be to late to make a change even if you've been a frank type 2 diabetic for 8+ years"