What exactly is insulin and why would your doctor prescribe it? Insulin is a naturally-occurring hormone in the body that allows your muscle, fat, and liver cells to absorb sugar (glucose), a source of energy for these cells, the American Diabetes Association (ADA) explains.

Common Fears About Taking Insulin

Though for some people taking insulin can be the answer to effectively managing diabetes, there are many persistent myths and fears surrounding its use. Here are some of the most common:

  1. Needing insulin means I’ve “failed” at managing diabetes. Many people dread starting insulin therapy because they believe it means that they’ve failed at diabetes management, according to the ADA. That’s a myth, says M. James Lenhard, MD, endocrinology section chief and medical director of Christiana Health Care Center for Diabetes and Metabolic Diseases in Newark, Delaware. Diabetes is a progressive condition, Dr. Lenhard adds. This means that most people diagnosed with diabetes will need to ramp up treatment as the years go on. This isn’t necessarily a reflection of how well you’re managing your diabetes but a fact of life with the condition.
  2. Insulin injections hurt. Because insulin must be injected, some people fear that the shots will be painful. That’s another myth, Lenhard says. Some of the newer needles used for insulin injection are as thin as a sheet of paper, so you don’t feel the pinch, he explains. Indeed, most people are surprised by how little they feel an injection, adds the Joslin Diabetes Center in Boston.
  3. I could have a bad reaction to insulin. Another fear some people have is that they might be allergic or react badly to insulin. Allergic reactions to insulin can happen, but they’re rare, the ADA says. In fact, 2 to 3 percent of people have allergic reactions to insulin, according to the Independent Diabetes Trust. Other allergens in the insulin, such as latex, may have been responsible. Moreover, your first injection will be done in the presence of your doctor, who is trained to handle any issues that arise. A bigger risk is a reaction at the injection site, such as itching or redness, but even this risk is small, the ADA says. You can reduce the risk of infection by using disposable needles and syringes only once and sterilizing any reusable medical instruments that you have, according to the ADA.
  4. Insulin will make me gain weight. For many, a big concern about starting insulin therapy is weight gain. While some people do put on extra pounds when they start taking insulin, says the ADA, it’s possible to avoid weight gain with a little extra effort, according to Lenhard. “It’s the size of your meals that make you gain weight,” he says, not the insulin itself. If you’re concerned about gaining weight when you start taking insulin, work with a certified diabetes educator or registered dietitian to help you eat appropriately for your size and get the right amount of activity to keep your weight in check, he suggests.

Adjusting to Insulin Therapy

You and your doctor will determine how much insulin you need and when you need to take it. Insulin dosing is dependent on your weight and any other health issues you may be dealing with, Lenhard says. Most people starting on insulin need at least one injection a day, according to the ADA. Some need two injections, while others may need as many as three or four. Some people take other diabetes medications as well, and some don’t. Your routine will be individualized for you, Lenhard notes. It’s also important to understand the type or types of insulin you’re taking — rapid-, short-, intermediate-, or long-acting — the ADA advises. You might also take a combination of these. Basal insulin (the intermediate- and long-acting forms of insulin) acts as background insulin, and helps control blood sugar during periods of fasting. Bolus insulin (rapid- and short-acting insulin) controls the rise in glucose that comes with eating a meal. Checking your blood sugar regularly is the best way to know whether your insulin medication is working properly, the ADA says. Generally, “if you can get your morning sugar level to fall into line,” Lenhard says, “the rest of the day will fall into line behind it.”

Knowing When to Tweak Your Insulin Routine

At times, you’ll likely need to make adjustments to your insulin treatment routine. For example, if you’re sick, you may need to take more insulin, Lenhard notes, because “any kind of sickness or illness can make your blood sugar go up.” Exercise also can affect your insulin needs, according to the ADA. Your body is able to better use insulin during and after physical activity, so it’s good to become familiar with how your blood sugar responds to exercise by checking your blood sugar levels before and after your workout.

A Note on Low Blood Sugar

It’s also important to be aware of the signs of hypoglycemia, when blood sugar goes too low. These include double vision, shaking, hunger, unclear thinking, and a pounding heart rate. People can accidently give themselves too much insulin, which can cause hypoglycemia, Lenhard says. Hypoglycemia can be dangerous, and you’ll need to eat some fast-acting sugar or take glucose tablets to get your blood glucose back to a safe range. Recognizing the signs and reacting quickly will put a stop to the progression of hypoglycemia. Most importantly, know that this new phase of your diabetes treatment will mean working closely with your doctor or diabetes educator to fine-tune your insulin intake to your lifestyle and unique needs. Over time, most people gain a level of comfort that allows them to use insulin most effectively to manage their diabetes. There’s no reason why you can’t achieve the same. Additional reporting by Brian Dunleavy