My Mental Readiness for Insulin

Twenty-five years ago I was pregnant with my last child. During that pregnancy, I had gestational diabetes. Fifteen years ago I was diagnosed with type 2 diabetes. For the first 8 years, I managed it with diet and exercise. In the 9th year, I needed medication to support my diabetic life. I adapted well mentally to the idea that medication was needed. I knew from the get-go that diabetes was progressive.

Diabetes progression but not quite ready for insulin

It took a while and several tries with the new and different meds to find the right ones for me. I did well on them considering how long I had lived with diabetes. I kept up a usually healthy diet. I exercised by walking. My endocrinologist wanted my A1C below 7. However, despite all my best efforts, it just would not come down below 7. I hovered between 7.2-7.4 for a few years. The topic of insulin had come up a few times but quite frankly, I wasn’t ready for it. I had this fear of it. There was no rhyme or reason for my fear. It was just there. Perhaps this will help explain.

Family doctor's suggestion: Start insulin

My family doctor was very concerned and wanted me to start insulin. We had several talks about this. More than I care to recall. In many of those conversations, I would put forward options for us to consider. He would pretty much kibosh all of them. I was starting to feel pressured by those conversations but I knew his professional heart was in the right place. He decided I should see a psychologist to help support me through this tough decision and he felt working out in the community throughout all of COVID-19 was causing me more stress than I realized. He was likely right about that last part. I agreed to the referral but my heart wasn’t in that either. I wondered if he wanted me to see a psychologist because I disagreed with him. Either way...I wasn’t ready to start insulin.

Endocrinologist's suggestion: Start insulin

My endocrinologist is a quiet and very patient doctor. I would ask the same questions of him that I did my family doctor, and suggest the same options I felt I had. He would talk about why those options were not the best and always we would meet on common ground for something I could try. He was more open to waiting and letting me do what I could first. We also talked about insulin. At one point I said, can you give me 6 months to see what else I can do? His response was a small smile and said that it wasn’t up to him, it was my choice. I really appreciated that because...I still wasn’t ready.

A cardiologist who truly listens

I also have a cardiologist. As you are aware, we can’t talk about diabetes without considering the impact on the heart. At all times, we want to avoid cardiac complications by preventing them. This doctor is a ‘tell it like it is’ kind of guy. He plays a little with sarcasm and to be honest, I really like that about him. He has a big sense of humor and I feel totally at ease with him. During my last check-up, he asked about my A1C. As an aside, I always find it funny: he has my test results in front of him because it’s online for all three doctors and me to access but he asks me nonetheless. Anyway, I told him that my family doctor had been pushing insulin and that I was scared. He asked me why. I said my biggest fear was screwing it up, calculating, and giving the wrong dose. To my surprise, he took off his doctor hat and talked to me in a gentle manner and as a fellow diabetic, not as a doctor. I knew he was also diabetic and that my endocrinologist was his endocrinologist by coincidence.

Insulin real talk and expectations

His first words were “You’ve got this." He said “You already give yourself a needle once a week (a non-insulin diabetic med). That’s what most people fear most, giving themselves needles. It’s one tiny needle at bedtime, that’s usually all that you need but sometimes there may be a second needed until your dose is regulated. Our endo would probably start you at 20 units. There’s nothing to screw up. It’s very easy. You can do this." I felt so relieved. I didn’t know it was likely one dose a day. I thought it’d be four. I knew in my head I needed insulin but my heart would not follow. He asked me if he could say in his letter to the other two doctors that we talked about insulin. I knew they were writing professional letters to each other after each visit they had with me anyway but I appreciated the ask. I agreed, they’re all part of my team.

Starting insulin with type 2 diabetes

Shortly after that appointment, I was to see my endo again. I was still trying to bargain with myself on a way to avoid the insulin so I asked all my ‘what if we try this or that’ type questions. It was apparent now for me, it was time. We talked about what it would look like to start insulin. Preloaded pen or vial? Pen. It was as the cardiologist said, one needle at bedtime. My start was 10 units, increasing by 1 unit each night until my morning blood sugar is under 7 for 3-4 days in a row. I looked at him and said, I need to hear the words from you. He asked me, "What words?" I need to hear you say it’s time. He just smiled and said, “It’s time.” He added that many people come back after and say they wished they had done it sooner.

A look back on my decision to start insulin

So now here I am, three weeks later, on the Lantus preloaded pen with a plan to be moved to Tresiba after the dose is regulated. Other than one big nasty-looking bruise with my first needle, and some stinging after most needles, it has gone well. It took 5 days to get my morning sugars down below 7 so I’m sitting at 12 units. I’m pretty happy with that.

I came across “The Features of Psychological Insulin Resistance” from Diabetes Canada after I started the insulin.¹ Wow. My face could be the picture for this ad. I couldn’t put my feelings into words until now.

Do I wish I had moved to insulin sooner? No. I’m not able to say that because I had to do it when I was ready. I’m glad my team worked with me until I was. I’m at peace with my decision so now, I can move forward.