To inject or not to inject
A common misconception is that you can get diabetes by eating sweets or too much rice. Understanding how diabetes develops involves knowing how the body reacts to the food that we eat.
All food is broken down eventually into glucose, the form of energy that the body can readily use. After we eat, the glucose (or blood sugar) level in our body rises and the pancreas produces insulin, a hormone that helps glucose enter the cells where it can be used, and glucose levels return to normal. Diabetes occurs when the pancreas cannot make enough insulin or when the body cannot use insulin properly, a condition called insulin resistance.
The main types of diabetes include type 1 diabetes mellitus (T1DM) where the pancreas cannot make any insulin at all. While typically seen in children, it can also occur at a later age, and can only be treated with insulin injections.
Type 2 diabetes mellitus (T2DM) accounts for around 90 percent of all diabetes cases and is the result of long-standing insulin resistance. Treatment includes developing a healthy lifestyle, exercise and a proper diet, and the use of tablets or if needed, insulin. Oral medications and insulin can also be combined. Being on insulin does not mean you have T1DM, but that the oral medications are not enough or are not the right medication for your current condition.
After your initial diagnosis and a treatment plan is formulated with your doctor, you will still need regular check-ups and to screen for complications. You may have blood tests to check for good glucose control, also for cholesterol, and liver and kidney function. Persons with diabetes should also see an eye doctor at least once a year.
Getting good control of your diabetes early on lessens the risk of complications occurring in the future, but remember that diabetes is a progressive disease and it can still worsen over time. As you get older, your level of physical activity and diet may also change. This means that your regimen may need adjustments, and medications may need to be increased in dosage or changed, sometimes with the addition of insulin.
There are many fears and mistaken beliefs surrounding the use of insulin. While some are afraid of needles, some think that being on insulin means that your disease has become very serious and you are near death. Some believe insulin causes cancer. Others may view it as having failed at managing your diabetes.
This should not to be thought of as something that you caused. It can be part of the natural course of the disease, and does not mean that you are dying. Initially, the pancreas can make extra insulin to make up for insulin resistance, but then eventually the pancreas is unable to make the extra insulin to keep blood glucose levels normal. In these cases, patients may need to add insulin injections.
There are now different formulations of insulin. Some are long-acting and only given once a day, and there are rapid-acting ones that are given right before or at the start of a meal. Some insulins are also combined to reduce the number of injections needed per day. Insulin also now comes in pens which are easier to use with smaller, thinner needles that make it relatively painless to inject.
Being on too much insulin can cause your glucose levels to drop too much, so it will be necessary to check your blood glucose levels more often. Traditional fingersticks can also be cumbersome and painful. You may want to ask your doctor about new diabetes technologies such as continuous glucose monitoring (CGM). This uses a sensor inserted just under the skin to get real-time readings of blood glucose levels. This technology makes it possible for you to respond immediately to high or low blood glucose and can give important information to help you make dietary and exercise changes.
It can be challenging to live with a chronic and progressive condition such as diabetes. A healthy diet, maintaining a healthy weight, staying active and taking medications properly don’t stop the progression, but only slows it down. The transition to insulin should also not mean that you give up these healthy practices. Remember to take care of yourself every day and check in regularly with your doctor to help manage your condition.
To learn more about insulin, diabetes, and other endocrine disorders, visit the website of the Philippine College of Endocrinology, Diabetes and Metabolism (PCEDM) at www.endo-society.org.ph. Also on Facebook, YouTube, Instagram and Twitter.
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