Insulin: When to Take It and Other Facts You Should Know

If you've been diagnosed with diabetes, you may have heard about insulin. A hormone that's produced in your pancreas, insulin is in charge of regulating the amount of sugar that's in your blood. If you don't make enough insulin naturally, your blood sugar may become too high, signaling that you have diabetes.

Insulin is prescribed according to your individual case of diabetes. It may seem complicated, but for many people, taking it becomes a way of life.

Here's a crash course on what you need to know if you are an insulin candidate.

What Is Insulin—A Hormone or a Drug?

"In a way, it's both," said Stuart Weiss, MD, clinical assistant professor of endocrinology, diabetes, and metabolism at New York University's Department of Medicine, NYU Medical Center.

According to MedlinePlus, insulin exists as a hormone in the body that provides a way for glucose, or sugar, to energize cells. "The beta cells of the pancreas make insulin and release it when you eat a meal. It lowers the blood sugar by multiple mechanisms but basically by causing cells to take the sugar out of the blood," said Dr. Weiss. "And for people who aren't making enough insulin on their own and must take it (by injection) to treat their diabetes, insulin is, technically, a drug."

How Often Do You Need to Take Insulin?

Your treatment plan depends on which type of diabetes you have, type 1 or type 2, and the progression of the disease.

In type 1 diabetes, the pancreas makes no natural insulin, so the patient must take insulin injections. The disease is a genetic condition that is typically present early in life. Additionally, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), environmental factors like viruses might also be responsible for the development of type 1 diabetes.

In type 2 diabetes, people make insulin, but it's often not enough or their cells don't respond properly, elevating blood sugar. Insulin injections are an option and not a requirement, depending on the specific case. Type 2 diabetes typically emerges later in life; however, it can come about due to lifestyle factors (e.g., being physically inactive) and genetics as well, according to the NIDDK.

If you have type 2 diabetes, the length of time you will need to take insulin will depend on a mix of factors. "Many people can eliminate their need for insulin if they eat less, exercise more, and lose weight and if their beta cells (which make insulin in the body) are still functioning adequately," said Dr. Weiss.

People with type 2 diabetes who are taking insulin are those who need more assistance controlling their blood sugar than diet, exercise, and oral medications can provide. Taking extra insulin can help preserve the functions of the pancreatic cells that are naturally producing the hormone, said Dr. Weiss. The earlier you start insulin, the higher the probability of needing just one injection per day.

"People whose disease has progressed further may need to take it several times a day, typically with each meal," he said. Whatever your specific needs are, you need to take insulin as prescribed. That doesn't mean that you won't miss an insulin dose from time to time, but fortunately, you can still manage your insulin level in these instances.

"I tell my patients who use insulin multiple times a day that if they miss a shot, they need to cut the carbohydrate content of the food they eat that day, drink more water to counter the dehydration associated with higher blood sugar, and eat more green vegetables and less starch," added Dr. Weiss. However, depending on the situation and the type of insulin, you may be able to take the missed shot once you remember you haven't had it.

Are Injections the Only Way?

If you're afraid of shots and worried about getting insulin injections, you may be relieved to know that insulin needles are small. And you have options. "There are also insulin pens equipped with an insulin cartridge and disposable needles that are so simple even a child can use them," said Dr. Weiss. "Either type of delivery system makes using insulin very easy and virtually painless—really."

According to the American Diabetes Association (ADA), another delivery system is the insulin pump: a "small, computerized device" that can deliver insulin as a surge (with your control) and as a steady, continuous, measured dose. The amount of insulin is adjustable, but insulin pumps are not for everyone with diabetes. "While these devices can be helpful for people with type 1 diabetes, for most (individuals with type 2 diabetes) they're not necessary," said Dr. Weiss.

Per the NIDDK, other options for taking insulin include insulin inhalers, jet injectors (devices that send high-pressured, fine sprays of insulin into the skin), and an artificial pancreas. An artificial pancreas is a three-part system that "mimic(s) how a healthy pancreas controls blood glucose," according to the NIDDK. It consists of:

• A continuous glucose monitor (CGM) used for blood sugar level tracking
• An insulin calculation program that receives blood sugar information wirelessly (through a smartphone or to the insulin infusion pump directly) from the CGM
• An insulin infusion pump—worn on a belt, in a pocket, in a pouch, or attached to the skin—that will deliver insulin based on the program's readings (i.e., if your blood sugar level is not in the necessary range)

The inhaler and jet injector methods are used less commonly than needles and syringes, pens, and pumps. Additionally, an artificial pancreas is typically used for treatment if you have type 1 diabetes; you would need to talk with your healthcare provider to determine if it would a good option for your situation.

Whatever your method, remember to be careful about how the insulin is stored. With open insulin, almost all types can be kept for up to a month at room temperature, without refrigeration, per the ADA. The American Diabetes Association has also advised against keeping it in extreme temperatures—hot or cold—and to check that your insulin looks normal before use. Finally, never use insulin past its expiration date.

What Lifestyle Changes Are Important?

Exercise is a natural way to lower blood sugar, particularly in patients with diabetes who are overweight or obese. A March 2021 International Journal of Physiology, Nutrition and Physical Education study found that after two months of physical exercise, participants experienced a "very significant decrease in blood sugar," with results as effective whether exercise was performed in short bursts or extended periods of time.

Blood sugar may drop during and after exercise, so it may be necessary to have a sugar source within reach after exercising in order to bring your blood sugar back up to the right level.

Even if you exercise appropriately, having a healthy diet is important as well. MedlinePlus suggests some of the following options:

• Nonfat or low-fat dairy
• Whole grains
• Proteins
• Fruits and vegetables

Limit your intake of starchy vegetables, including potatoes, corn, and peas, or fruits like pineapples, grapes, and cherries. These carbohydrates break down into sugar once digested and can have an adverse effect on your blood sugar, causing it to rise, according to the ADA.

With the diet above, you may experience both weight loss and weight gain. "Weight gain is the first sign that your diabetes is under control, whether it's with oral agents or insulin, because your body starts being able to process sugar again," said Dr. Weiss.

What Are Other Considerations When Taking Insulin?

With an active and more healthful lifestyle, it's possible to reduce the need to have extra insulin. Additionally, those who have to take insulin but have better blood sugar control are less likely to develop complications from diabetes such as nerve damage, heart disease, and blindness.

Still, there are other considerations when you take insulin. One issue is insulin resistance, in which you become less sensitive to insulin and need more of it to reduce blood sugar. "Insulin resistance further depletes the insulin-producing cells of the pancreas and leads to progression of diabetes," Dr. Weiss noted. However, lifestyle changes can make a difference when it comes to improving insulin sensitivity.

Another concern is hypoglycemia, which occurs when you have too much insulin in the body, so—according to MedlinePlus—blood sugar drops too low. Symptoms include anxiety and confusion, sweating, hunger, and, in rare cases, seizures and coma. "The kind of severe hypoglycemia that would cause someone to go into a coma is extremely rare in people with type 2 diabetes," Dr. Weiss said. Hypoglycemia is a bigger issue if you have type 1 diabetes.

To prevent this, make sure to match your insulin intake to your food intake, which can take some trial and error. Sugar sources can also help alleviate the symptoms of hypoglycemia. According to a November 2020 Acta Biomedica study, researchers noted that "glucose tablets should be used to treat hypoglycemia"—glucose tablets raise blood sugar faster than food can.

"Insulin is a very, very safe therapy, and people should not hesitate to use it if needed," said Dr. Weiss. As with any concerns about medication or treatments, talk with your healthcare provider to get the answers you need.