Type 2 Diabetes and Insulin—12 Myths Explained

People With Diabetes Always Need Insulin

This is a semi-myth. According to the Centers for Disease Control and Prevention (CDC), people with type 1 diabetes (about 5% to 10% of those with diabetes) do need insulin.

If you have type 2, which includes 90% to 95% of all people with diabetes, you may not need insulin.

Of adults with diabetes, only 14% use insulin, 13% use insulin plus oral medication, 57% take oral medication only, and 16% control blood sugar with diet and exercise alone, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

The point of insulin is to get blood sugar, which can be harmful in the body in the wrong amounts, to a safe level.

Insulin Means You've Failed

"This is a big myth," Jill Crandall, MD, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. said.

"Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin," Dr. Crandall said.

Type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to ensure your blood sugar is in a healthy range. Eating a healthy diet and exercise will always be important, but medication needs can vary.

The American Diabetes Association (ADA) reports that it can become harder to reach your diabetes treatment targets even though your medication, exercise routine, diet, or other things haven't changed—and that's normal.

"A large percentage of people with type 2 diabetes will ultimately need insulin, and we don't see it as a failure," said Dr. Crandall.

Insulin Injections Hurt

One of the myths about insulin is that the injections are painful. "This is absolutely false," said Dr. Crandall. "With the small fine needles we have today, insulin injections are close to painless, if not painless."

In fact, many people would say that the finger pricks used to measure blood glucose levels hurt more than insulin injections.

"When people get their first injection, they often say, 'I can't believe it didn't hurt,'" said Dr. Crandall. What's more, you may not need to use syringes at all.

There are injector pens on the market that allow you to dial the dose of insulin, snap on a tiny needle, and inject painlessly.

Insulin Can Cause Dangerously Low Blood Sugar

This one is possible. However, per the ADA, low blood sugar (hypoglycemia) typically only happens if you use insulin or other medications that can lower blood sugar to treat your type 2 diabetes.

An international study published in 2016 in the journal Diabetes, Obesity, & Metabolism examined rates and predictors of hypoglycemia in those with type 1 and type 2 diabetes. Patients needed to take insulin to control their diabetes to be included in the study.

In a four week period, 83% of patients with type 1 diabetes and 46.5% of patients with type 2 diabetes experienced a hypoglycemic event (low blood sugar).

If you do take insulin to manage your diabetes, it is important to note that each person's reaction to low blood sugar may be different, according to the ADA. However, many people with type 2 diabetes can recognize their symptoms.

The ADA lists many possible symptoms of low blood sugar, such as anxiety, shaky hands, sweating, and an urge to eat. A prolonged episode of low blood sugar could cause unconsciousness.

According to the ADA, the 15-15 rule, often used to treat low blood sugar (a blood sugar below 70 mg/dL), involves consuming 15 grams of carbohydrates—such as hard candy, diluted juice, or glucose tablets—and then checking your blood sugar again after 15 minutes.

If your blood sugar is still low, continue the process until it is 70 mg/dL or above—and then follow this process with a meal or snack to help your blood sugar stay up.

There may be different amounts of carbs to take if the person experiencing low blood sugar is a child or if the blood sugar is so low that the patient is unable to safely consume food. Good communication with a diabetes treatment team is essential to understand individual approaches.

Additionally, if someone is unconscious or unable to treat themselves, it is important to recognize this is a medical emergency and call 911.

Insulin Is Forever

This is a partial myth. Some people with type 2 diabetes may need insulin temporarily, such as right after they're diagnosed or during pregnancy, whereas others may need to stay on it indefinitely, according to Joslin Diabetes Center.

People who lose a lot of weight may find that they no longer need insulin. While others who lose weight may still need it. Johns Hopkins Medicine explained weight loss and exercise can both contribute to improved blood sugar control.

It largely depends on how much damage diabetes has done to the insulin-producing cells of the pancreas. "It is not always a one-way street," said Dr. Crandall.

If you're wondering about your insulin requirements, check in with a healthcare provider.

Insulin Is Difficult To Take

Gone are the days when insulin injections were bulky, conspicuous, and difficult to administer.

"Today, insulin comes in pen injectors that are easy to carry with you, don't require refrigeration, and can be used discreetly, often just once a day," said Dr. Crandall.

"There are a large variety of insulin and insulin regimens that are much more convenient than they used to be," said Dr. Crandall.

Oral Medications Are Better Than Insulin

Oral diabetes medications can be a good solution for lowering blood glucose levels. One medication often used to treat type 2 diabetes, metformin, is considered safe, with rare side effects uncommon, per Harvard Health Publishing.

Still, oral medications don't work for everyone. "For some people, insulin is the easiest and best because it always works, but some people respond to pills, and others don't," said Dr. Crandall.

Not all oral medications have a tried-and-true safety record. For example. Avandia was restricted by the FDA because of research suggesting that it increased the risk of heart attack.

Insulin Will Make You Gain Weight

This is another partial myth.

Some people with type 2 diabetes may gain weight after starting insulin therapy.

The reason for the weight gain is that when treatment with insulin is working, the body begins to process blood glucose appropriately. This can result in weight gain and is one reason unexplained weight loss can be an early symptom of diabetes.

In addition, a 2017 study in the journal Diabetes Care saw a link between weight gain and increased inactive behavior in people after starting insulin therapy.

The good news is that weight gain tends to level out as insulin therapy continues, and the weight gain may be short-term, said Dr. Crandall.

People With Type 2 Don't Make Insulin

This is a myth. People with type 2 diabetes may actually produce higher-than-normal levels of insulin earlier in the course of having diabetes, a condition known as hyperinsulinemia, according to the ADA.

This happens because type 2 diabetes is caused by insulin resistance, a condition in which the body loses the ability to respond normally to the hormone, per the CDC.

Taking insulin can help overcome insulin resistance and take the place of naturally occurring insulin production, which does tend to decrease over time.

Insulin Means Your Diabetes Is Serious

The truth is diabetes is a serious condition, but it is treateable and maneagable.

High blood sugar is unhealthy for your body and can cause damage to very small blood vessels. According to the National Kidney Foundation, the sugar "sticks" to your small blood vessels, which makes it hard for blood to get to your organs.

This can result in damage to the heart, kidney, eyes, nerves, and feet.

And it's why blood sugar control—whether through diet, exercise, medications such as oral medications or insulin, or a combination of these methods—is so important.

Insulin Use Requires Multiple Daily Injections

Not always. If you need insulin, you have options, according to the CDC.

You can try a long-acting once-a-day insulin (usually given at night), which mimics the low level of insulin normally found in the body all day long.

This may be enough to control blood sugar on its own, or it can be combined with oral medications.

If blood sugar is still too high after meals, however, you may need to take insulin several times a day, just before eating, per the ADA.

If insulin is part of your diabetes treatment plan, a healthcare provider can help you determine the type and amount.

Insulin Is a Treatment of Last Resort

Although some people exhaust all possible diabetes treatments before using to insulin, this may not be the best strategy.

"By the time a person with type 2 starts insulin therapy, they likely already have diabetes-related complications because of poor blood sugar control," said Dr. Crandall.

Poor blood sugar control can increase the risk of heart attack, stroke, and other health problems, according to Johns Hopkins Medicine.

So, it's important to work with a healthcare provider to establish a treatment plan that works for your particular health needs.

In fact, starting insulin sooner may avoid complications, help oral medications work better (and be effective longer), or allow you to use a less-complicated insulin regimen for a longer period of time.