Читать книгу American Diabetes Association Guide to Insulin and Type 2 Diabetes - Marie McCarren - Страница 8
ОглавлениеFROM: V53
I just received the news yesterday from my drs. and nurse that my blood tests showed I will have to go on insulin!!! I don’t know what I feel hearing that. I have been a mess. I cry every time I start to think about it. How am I going to deal with this now? Help. Thank you.
Many people with type 2 diabetes will need insulin at some point. But when their doctors bring it up, many just say no. Why?
Researchers asked 708 people with type 2 diabetes this question: “Are you willing to use insulin if it’s prescribed?” More than a quarter said they were not willing to take insulin. Here are the choices people were given, and the percentage of respondents that picked that reason. (They could pick more than one reason, so these options will not add up to 100%.)
“Insulin can cause problems, such as blindness.” (17%)
“Taking insulin means my diabetes will become a more serious disease.” (47%)
“Insulin therapy would restrict my life; it would be harder to travel, eat out, etc.” (56%)
“I’ve done everything I was supposed to; if I had to do insulin therapy, it just wouldn’t be fair.” (42%)
“I couldn’t take the needle every day. It would be just too painful.” (51%)
“Insulin therapy might cause serious problems with low blood sugar.” (49%)
“I’m not confident I could handle the demands of insulin therapy.” (58%)
“Insulin therapy would mean I had failed, that I hadn’t done a good enough job taking care of my diabetes.” (55%)
“Once you start insulin, you can never quit.” (53%)
Here’s one statement that we hear often but was not included in the study: “Insulin will make me gain weight.”
Those are people’s beliefs. What’s the real story?
THE TRUTH ABOUT INSULIN
What You Might Be Thinking: “Insulin can cause problems, such as blindness.”
Truth: Let’s say a person develops pneumonia. He goes into the hospital and is treated with antibiotics. But the disease has progressed, and he dies. Did the antibiotics kill him? No. Antibiotics were just used too late. It’s the same with insulin. If you use it early enough, it actually prevents diabetes complications.
What You Might Be Thinking: “Taking insulin means my diabetes will become a more serious disease.”
Truth: Diabetes is a serious disease, because it can lead to serious health problems. The higher your blood glucose levels, the higher your risk of developing diabetes complications. Don’t judge your diabetes by how much medication you are taking. Judge it by your blood glucose levels. Keep them near the normal range and you will be healthier.
SUBJECT: WORRY ABOUT DIABETES, NOT INSULIN
FROM: D3
Folks should not get upset about the type of treatment they need, they should only get upset if their BS goes up and stays up.
What You Might Be Thinking:“Insulin therapy would restrict my life; it would be harder to travel, eat out, etc.”
Truth: You might start with just one injection a day, done at home either in the morning or before bed. If you need to take insulin during the day and don’t want to fuss with syringes, try an insulin pen (see Insulin Pens). People find them convenient and discreet.
SUBJECT: IS INSULIN OBVIOUS?
FROM: s3w
My wife was diagnosed with Type 2. Today we met the doctor and he prescribed insulin: Short-acting insulin 4 times a day based on the readings and then long-acting insulin twice a day. I am so frightened with this!!! Is there something to be worried that she will be taking insulin at the age of 25? Does this mean we cannot go out, as she cannot take the shots in the open? I am really getting depressed seeing her as she is losing weight and also looks so down. Please advise!
FROM: D3
I just took a vacation. Drove from Texas to NJ and spent two weeks on the Jersey shore. I gave some of my injections in the car. I have injected discreetly in a restaurant. I was a little bit shy too when I started injecting, but now I have the opinion that as long as I am discreet about it I can do my BS readings and inject my insulin. It is no different in my opinion when a mother chooses to breast-feed in public. Some do and some do not. It depends on the mother and what she is comfortable with.
FROM: jj
For dining out, I take my meter with me and test before my meal, in the restroom. Or if no one is around my table, I have tested right at my table! I also make sure I retain the test strip in a little plastic bag in my meter kit and empty it when I return home. You can fit these things into your routine—it just takes time and practice.
What You Might Be Thinking: “I’ve done everything I was supposed to; if I had to do insulin therapy, it just wouldn’t be fair.”
Truth: We agree with you on this one, but you still want to do the best you can to take care of your diabetes. Insulin can help you do that.
What You Might Be Thinking: “I couldn’t take the needle every day. It would be just too painful.”
Truth: You may be thinking of the types of needles used for vaccinations. Those are bigger because they need to reach muscle. Insulin syringes have much shorter and thinner needles because you inject insulin just under the skin. The needles also have a coating to help them slide into the skin. Most people find that insulin injections are nearly painless.
Try This: Ask your health care provider to show you an insulin syringe and give you a trial injection.
SUBJECT: INJECTIONS AND PAIN
FROM: D
It’s not as bad as the &@#^ finger pokes. The finger sticks make me wince almost every time, dreading the poke. I don’t do that with insulin.
FROM: R2
I was really scared to take insulin. I thought I would never be able to give myself a shot ’cause I was always afraid of needles. Well, two weeks in and I’m a pro. Everything the folks have posted here is true, including that the jab you get when you test hurts more than the shot. I was surprised.
FROM: th63
I went to the endo yesterday. We decided it was time for me to try insulin. Was the first shot scary? Yes, it was. But, did I do it? Yes! And did it hurt? No, not even a little! Now I can eat a little more reasonably, and I am so proud of myself for being able to do this!
What You Might Be Thinking: “Insulin therapy might cause serious problems with low blood sugar.”
Truth: You’ll be starting on a very low dose of insulin, so the risk of hypoglycemia is very low. In studies, people using long-acting, peakless insulins had fewer lows than people using NPH.
Try This: Ask your diabetes educator to go over the symptoms of hypoglycemia and what to do if it happens. (See The “Lows”: Prevention and Treatment.) Also ask how drinking alcohol raises your risk of hypoglycemia.
SUBJECT: BLOOD SUGAR LOWS
FROM: hb
I was diagnosed in 2003 and since the beginning my doctor put me on insulin shots: Humalog before meals and Humulin NPH before bedtime (four shots a day). I must say that I do have lows sometimes but never of the severe type. I have them mostly around 3:30 to 4:30 in the morning when the NPH is at its peak. I sense it coming and I take 10 grams of glucose and about 10–15 grams of brown bread. My doctor has advised me to go on glargine insulin.
FROM: jl
I, too, take NPH (but no other insulins) and was having nighttime lows. I switched my dosage times and am now taking two shots of NPH instead of one. This has really helped me! I take 6 units in the morning and 3–4 units in the evening, usually around supper.
What You Might Be Thinking: “I’m not confident I could handle the demands of insulin therapy.”
Try This: Make an appointment with a diabetes educator (see Prep Before You Go). You’ll leave feeling much more confident.
SUBJECT: LEARNING INSULIN IS EASY
FROM: D3
Yes, you have to learn to give an injection and to deal with the specifics of how the insulin you are given is used. But if you can do your BS readings, an injection is not that hard. Good luck and dry those tears.
FROM: MM4
You will have to learn to count carbs if you don’t do this already. If you haven’t been to a diabetes education class, now is the time to get signed up. The diabetes educators can teach you all of the things you need to know when you are on insulin. Hang in there. This isn’t the end of the world. The damage caused by uncontrolled diabetes is far worse than inconvenience of an injection.
What You Might Be Thinking: “Insulin therapy would mean I had failed, that I hadn’t done a good enough job taking care of my diabetes.”
Truth: As you get older, your pancreas makes less and less insulin. It’s not your fault; it’s the natural progression of the disease. You need to use insulin now.
SUBJECT: INSULIN IS NOT A SIGN OF FAILURE
FROM: MM4
OK, are you feeling defeated, that diabetes has won out, that taking insulin is the worst thing that could happen to you? Join the club. Most of us had the same feelings and yet, every day that I am on insulin, I count my lucky stars. And you are probably saying right now, “This person is nuts!” I felt so defeated when my doctor first suggested insulin.
I’d done so well for so long that this just seemed like the end. I tried one more oral med for four months and, with my A1C still going up, made the decision to accept the doctor’s recommendation.
FROM: D3
Too often I see patients and Drs staying with oral meds too long because many feel like going to insulin is akin to admitting to failure. It really should not matter how (which treatment option) a person chooses to get and maintain control of their BS, only that control is maintained. But sadly some Dr’s use insulin as a threat.
Do not forget this is a progressive disease. Sometimes you can do everything right—eat right, exercise, lose the weight, take your pills—and the pancreas still gets tired, insulin production drops, and no amount of stimulation works. That is when you have to move to insulin.
What You Might Be Thinking: “Once you start insulin, you can never quit.”
Truth: This is true for most people. A few people are able to stop using insulin. A person might be very insulin resistant because he or she is very overweight. If he loses a lot of weight, he might not need to use insulin. Some people have very high glucose levels when they are first diagnosed. They may need insulin at first. This will relieve the effects of high blood glucose. Then they may able to control their diabetes without using insulin for a time.
What You Might Be Thinking: “I’ll get fat.”
Truth: Studies show that when people keep taking metformin when they add insulin, they often don’t gain weight. Without metformin, average weight gain is 5–10 pounds. Don’t refuse insulin because of possible weight gain. Your high glucose levels are doing more harm than gaining a few pounds will.
SUBJECT: INSULIN DOES NOT EQUAL FAT
FROM: MM4
You might gain some weight, but it really comes down to what you eat. Generally, if you’re on insulin, you feel so much better that eating kind of becomes fun again. It’s not automatic that you gain weight on insulin—it’s up to you to continue to manage your diabetes with a good diet and continued exercise.
FROM: Hml
Insulin itself doesn’t make you gain weight; it just frees you up to eat a little more like you shouldn’t. It’s still all about spending more calories than you take in.
FROM: VV
I was on a steady losing streak with my weight until I went on insulin (Lantus and Humalog). Since then I have lost only a minimal amount. I feel so much better though and know this is simply because my body is better using the food that I eat. With regular exercise and good eating I do continue to lose weight, although VERY slowly. Probably about three pounds in the last three weeks. It can be frustrating, but I try to concentrate on how much better I feel and how much healthier I am.
FROM: g3
The weight gain is only when you get the dosage incorrect. You will get an urge to eat whenever you get either a low BG or can’t tell if you are full because you won’t get the BG spike that triggers fullness. If you eat bulky foods such as root vegetables, then you will get another trigger for fullness. Watch your diet and you won’t gain weight.
FROM: BK
Regarding the shorter-acting insulins, you do have to be careful not to “cheat” more because you can dial up a higher dose to cover the indiscretion. Having said that, on the few occasions when I did eat a bit more than I should, it’s been great to have the insulin to help. Good luck to you!
FROM: BA
Be extremely rigorous in portion control! Many of us have a really hard time estimating portion size by looking at it. Never mind the deck-of-cards and ping-pong ball comparisons. Weigh or measure the food. I was following my RD’s plan and not losing weight. She said, “You are eating all the right things—now tighten up portion control.” I bought a kitchen scale and began using it. Lo and behold, I also began losing weight. Try it for a few weeks and see if it makes a difference.
FROM: dec
I take 42 units of Lantus at night, with Humalog for sliding scale/carb covering, and 1,000 mg of metformin each night. I have been losing five pounds per month. I started at 20 minutes on the treadmill, and over time increased it quarter mile by quarter mile. Now that I’m steady on 30 minutes, the next thing will be to increase the incline so my body is doing more work.
As far as diet, I count carbs but not calories. I try to balance the carbs (the good ones, you know) with protein and with good fats. Everything in moderation. My approach is one of continual small changes/improvements, so I don’t feel deprived.
The exercise is what’s tipped the balance for me. I haven’t radically changed my eating habits since buying the treadmill, except for switching to 2% milk in my almost-daily Starbucks lattes.
Total weight loss is 65 pounds so far. Type 2 diabetes dx was the “rock bottom” for this little food addict, and I’ve been climbing back to redemption ever since.
FROM: fha
I’ve read that diabetics have energy-efficient metabolisms. This means we can survive on fewer calories, which is great in a famine, but not so great in a feast. So it doesn’t really matter what meds we’re on, an energy-efficient metabolism will cause us to gain weight if we eat more than we burn, and we burn slower than most. It helps me to think of it that way.
