Type 2 diabetes – time to start insulin? Ten things to ask your diabetes healthcare provider

1. Why do I need insulin?

Insulin is a hormone produced by the pancreas that carries glucose into the cells of your body to be used for energy. If you have type 2 diabetes you make insulin, but not quite enough. Think of using insulin to ‘top up your tank’ to keep your blood glucose levels under control.

2. What type of insulin do I need?

It is most common to use insulin once or twice a day. This is called ‘basal’ insulin. Basal insulin reduces blood glucose overnight and between meals. This type of insulin can be long-acting (Lantus^®, Basaglar^® or Levemir^®), longer-acting (Toujeo^® or Tresiba^®) or intermediate-acting (NPH). Longer-acting insulin has less risk of causing low blood sugar (hypoglycemia).

3. How much insulin do I use?

Whatever dose you are started on – usually 10 units once a day – it will almost certainly not be the right amount of insulin for you. Insulin is started at a low dose to reduce the risk of low blood glucose. Your health care team will then work with you to make sure you are adjusting your insulin to achieve your target blood sugar levels.

4. What times of day do I inject insulin?

Basal insulin is given once daily, either at bedtime or first thing in the morning. Sometimes this depends on which insulin you will be using and your preference.

5. What part of the body do I inject insulin?

Insulin should be injected into your abdomen, your outer thighs, or your upper buttock. It is not recommended to use the back of your arms for self-injection. It is very important to develop a good rotation practice, i.e. using many injection sites and rotating within the sites to keep your tissue healthy.

6. What devices are used to inject insulin?

Most people use insulin pens, either disposable or reusable, to deliver insulin. These are easy to use and help ensure the correct dose is being given. Less common is drawing up insulin from a vial and injecting with a syringe, or an insulin pump which is programmed to meet different insulin needs throughout the day.

7. What are the side effects of insulin?

The most common side effects of insulin are low blood glucose and weight gain. It is also important to eat regularly and to plan for exercise to reduce the risk of low blood sugar. This may include having a snack before doing physical activity, especially if not planned. Weight gain can be managed by maintaining a healthy lifestyle. It is important to keep active and eat healthy foods.

8. How often will I need to test my blood sugar?

It is suggested that you check your blood glucose level as often as you take insulin. When you are taking basal insulin, your fasting blood sugar is used to help make decisions about increasing your dose. It is also important to occasionally do another blood glucose test at another time of day. Testing at different times of day can help identify when your blood glucose is out of control.

9. How should I store my insulin?

Insulin that is currently in use can be stored at room temperature for 28 to 56 days, depending on the kind of insulin you are using. Ask your pharmacist or your diabetes team about proper storage of the insulin that you are using. Insulin that is not in use should be stored in the refrigerator.

10. Do I need to continue taking my other diabetes drugs?

It is very common to continue taking all of your oral diabetes drugs when you first start insulin. As your insulin dose increases, it may become necessary to reduce or stop some of your other diabetes medications to prevent you from having a low blood sugar. Your diabetes team will instruct you if any changes are required to your other diabetes drugs.

Remember – think of insulin as ‘boosting’ your own supply to help you achieve your blood glucose targets. Your diabetes team will help you to titrate your insulin and answer any questions you might have.