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Starting Insulin: When Pills Are Not Enough

When Angela Younger was diagnosed with type 2 diabetes after her daughter's birth in 1993, she didn't pay much attention to her disease. Angela was prescribed oral medication, but she rarely took it.

It wasn't until her mother died from diabetes complications several years later that Angela began to take her disease seriously. "I saw a new doctor who sat me down and explained how important it was," she says.

How insulin helps

Some people worry that starting insulin is a "defeat," but that's just not true. Even if you do everything right with your health, there may come a time when taking oral medication is not enough. "Many people with type 2 diabetes will probably need some form of insulin replacement after eight to 10 years," says Luigi Meneghini, MD, MBA, director of the Eleanor and Joseph Kosow Diabetes Treatment Center at the Diabetes Research Institute in Miami.

Deciding if insulin is right for you

Your doctor can help you decide if it is right to start insulin. If you're not sure you want to commit to daily injections, keep in mind that insulin is easier to take today than years ago. "The needles are much smaller, or you can use a prefilled pen or a pump," says Angela. Also, insulin doesn't have to be refrigerated. "When I go to a restaurant, I throw an insulin pen in my purse, and I don't have to worry about going to a hotel with a refrigerator."

Today, at age 46, Angela, an adult nurse practitioner and certified diabetes educator living in Branford, CT, takes a different approach.

Her doctor put her on intermediate-acting insulin in 2000, so she could improve blood sugar control. In 2003, she began taking long-acting (basal) insulin every 24 hours. Today, she takes both long-acting insulin and rapid-acting (bolus) insulin with two meals a day.

For Angela, the decision to start insulin has been a positive experience. Her blood sugar levels are under control and she no longer has trouble with high blood pressure or high cholesterol, two diabetes complications. "Sometimes you get sick of this and wish it would go away," says Angela. "What keeps me motivated is my daughter."


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