Changing from Tablets to Insulin

People with diabetes should and can expect to have the best control of their condition that can be safely and reasonably achieved. This needs a continuous review of their treatment to ensure it is matched to their body’s needs. Eventually, insulin treatment is needed for most people who started with diet and tablets because these will usually only work for a limited time – longer in some and shorter in others.

Why do I need insulin?

In people who have Type 2 diabetes, the pancreas may still produce some insulin, but it either does not produce enough or the body cannot use it properly. To make the most of your body’s insulin and to keep your blood sugar controlled, you will know that you need to watch your weight, eat healthily and stay as active and fit as you can. This healthy lifestyle is the bed rock to other treatments – without that, it‘s hard to get good sugar control even if you take many tablets. .The tablets work by making your body either use its insulin better or make more insulin. Gradually the pancreas gland makes less and less insulin and the tablets are no longer effective. When that time comes, as it does for the majority of people with Type 2 diabetes, they will eventually have to switch from tablets to insulin otherwise their control will worsen no matter how hard they try with their diet.

When will I now that time has come?

This won’t happen all of a sudden. It’s a gradual thing. Despite your best efforts with your diet and weight, your blood sugar tests will start to creep up. Once you are on the top dose of the diabetes tablets, insulin will be required if your pre-meal blood sugar levels are higher than 7 mmol or the HbA1c (long term average blood test) is greater than 7.5%.

Why can’t I just wait and see what happens?

Many people need some time to come to accept insulin treatment but putting it off too long just means that you will have poor control and that can do you harm in the long term. If you are already on the maximum tablet treatment and you are trying your reasonable best with you diet and lifestyle then things are not going to get better on their own – in fact they will gradually continue to get worse. When it’s clear you need insulin, don’t put it off.

I don’t feel ill so why should I change to insulin?

Many people do not have any symptoms (such as thirst, tiredness) even though the blood sugar levels are high. Even so, most people, even if they have not felt ill, do feel much better after starting insulin. What really is happening is that people get used to being slightly below their best. It’s only when they have been on insulin that they can look back and realise this.

Do I now have Type 1 diabetes?

No, you still have type 2 diabetes but need insulin to control your blood sugars as do many other people like yourself.

Will the injection hurt?

Most people, once over their initial fear, are surprised how painless it is and say pricking the finger to obtain blood hurts more than the insulin injections.

Will I be able to choose which insulin I have?

In consultation with the nurse, who will show you a variety of insulin delivery systems, you will be able to decide which type regime and gadget suits you best. Most people have twice daily injections of mixed insulin to start with.

How will I know what to do?

The nurse will visit you at home or see you at the centre and teach you how to inject. You will have as much help and support as you need. Don’t worry – remember there are thousands of people like you locally who have gone through the same concerns and they have managed perfectly well. At the end o the day you will be in full control of this and will be able to look after yourself without help from anybody. It’s just a question of learning how to do it and it’s no where near as hard as you may think.

How much insulin will I need?

The dose you require is based on many factors which include your weight, lifestyle, age and duration of diabetes. The nurse will calculate this initially and will alter the doses based on your blood sugar levels. But eventually, following education you will be able to make your own adjustments. The correct dose of insulin is the one which puts your own diabetes back into safe and good control. It varies a lot between people. As a rough guide it’s between 1⁄2 and 2 units of insulin per kg body weight. Also the dose is not fixed but will change over time – just as your dose of tablets had to change over time.

Seeking advice and what care to expect

Your self monitoring and regular reviews should leave you with a clear idea of whether your diabetes is well controlled. If not, then your treatment should be adjusted. When you are getting near the full dose of tablets, your health team will start talking to you about the need for insulin and preparations should be made for that. By the time the final decision has to be made – you should have a very clear idea of why insulin needs to be started and what is involved. It will be your choice to go onto it – don’t feel forced into starting. Once you start you will have a full education and training programme and close follow up over the next few months to get everything stabilised again. At the end of that you should feel happy and confident in what you are doing and be able to manage things yourself. At any time in the future, if you feel things are not right, you will be able to get more support and help as you need it.