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Insulin: What to expect week 1, month 1 and beyond

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When you have diabetes, your blood sugar is too high — you may need medication to help keep it steady. Find out how insulin works and how it will help you feel better.
Written by Koren Wetmore
Updated on October 21, 2022

If you or a loved one has diabetes, you’re well aware of the importance of insulin in your body.

When you eat, your body breaks down food into glucose, or sugar. The body uses it for energy. Normally, that sugar gets into your cells with the help of insulin, a hormone made by your pancreas.

When you have Type 1 diabetes, your body doesn’t make insulin. With Type 2 diabetes, your cells stop responding to insulin, even at high levels. This creates insulin resistance.

“Insulin is like the key that unlocks the doors to let glucose into your cells,” says Amy Egras, PharmD. She’s an associate professor of pharmacy practice at Thomas Jefferson University College of Pharmacy in Philadelphia. “In Type 1, you don’t have the key [insulin] to open the doors, so your blood sugar stays elevated. In Type 2, there’s something wrong with either the key [insulin] or the lock [your cells], and your blood sugar stays elevated.”

If you have Type 1 diabetes, you need insulin therapy to make up for what your body can’t produce. With Type 2 diabetes, insulin can help manage blood sugar when oral diabetes medications, such as Glucophage® (metformin), can’t do it alone.

Sometimes insulin is used to manage gestational diabetes as well. That’s diabetes that can occur during pregnancy. It usually goes away after giving birth.

Types and amounts of insulin

The 2 most common forms of insulin are long-acting and rapid-acting. Long-acting insulins help to control blood sugar throughout the day. They last up to 40 hours, depending on the insulin you’re given. These include Toujeo® (glargine), Levemir® (detemir) and Tresiba® (degludec).

Rapid-acting insulins regulate your blood sugar after you’ve eaten a meal. These might include NovoLog® (aspart), Apidra® (glulisine), Humalog® (lispro) and Humulin® or Novolin® (regular or neutral insulin).

Your dosing regimen will be tailored to your specific needs. Type 1 patients may have started doses based on their weight. Those with Type 2 diabetes may start with 10 units of insulin per day. Your dose will be adjusted up or down over time based on measured blood sugar levels, Egras says.

You’ll need to check your blood sugar levels daily. This is typically done with a device such as a glucometer. (Check out these other high-tech ways to make living with diabetes easier.) You’ll likely be asked to check it before your first meal of the day. Tracking your levels helps your provider to adjust your insulin dosing as needed.

How is insulin injected?

Insulin is usually injected with a vial and syringe, an insulin pen or an insulin pump. You’ll want to talk with your health care provider to figure out which option is best for you.

“Insulin pumps allow for very specific settings, so you don’t have to do a bunch of math in your head. Insulin pens are the most commonly prescribed because of their ease of use,” says Brittney Migliozzi, PharmD. She’s a faculty instructor and clinical pharmacist at Loma Linda University School of Pharmacy in Loma Linda, California.

Insulin therapy helps diabetes patients avoid issues such as blindness, heart disease, foot problems and kidney damage.

Be sure to search for your prescription on the Optum Perks discount app before heading to the pharmacy. You could find medication coupons for up to 80% off.

Here’s what you can expect as you start insulin therapy:

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Week 1 on insulin

Your biggest hurdle will be learning how to give yourself insulin injections. With Type 1 diabetes, you’ll start with personalized doses of long- and rapid-acting insulins. If you have Type 2, you’ll likely begin with an injection of 10 units of long-acting insulin once a day. Then, if necessary, based on your blood sugar levels, you may begin to take 4 units of rapid-acting insulin with your largest meal of the day.

You may not feel any different right away. But if your blood sugar has been very high (in the 300 to 400 range), you may feel tired, dizzy or shaky. You may even get a headache. That’s because your body is adjusting to lower blood sugar levels.

Week 2 on insulin

Your doctor may now adjust the amount of insulin you’re taking, depending on your blood sugar levels. Your previous diabetes symptoms — such as thirst and fatigue — may start to fade. You may also notice some weight gain.

“The reason people gain weight when they start insulin is they have excessive blood glucose in their blood,” Egras says. “And when there wasn’t any insulin or the insulin wasn’t working properly, then the blood glucose isn’t being utilized. Once insulin is started, now the body can take up glucose into cells, and because it’s usually more than their body needs, it gets stored as fat.”

Lifestyle changes such as eating balanced meals and exercising can help offset this side effect.

Weeks 3 and 4 on insulin

By now, you’re accustomed to the pattern of your insulin injections. Your dose may increase or stay the same, depending on your blood sugar levels. You may also feel that you have more pep. “The blood sugar is now entering your cells, so you have more energy,” says Migliozzi.

Month 2 and beyond

At this point, your body has become used to normal ranges of blood sugar. You may begin to notice benefits such as clear thinking (no more brain fog), fewer trips to the bathroom and continued energy.

Your doctor may order an A1c blood test. This indicates your average blood sugar level over the past 2 to 3 months. A change such as weight gain or loss, increased physical activity or pregnancy can alter blood sugar levels and, in turn, insulin needs. (By monitoring blood sugar levels, it’s also possible to catch and manage pre-diabetes before it progresses into Type 2.)

Working with your health care provider, you’ll discover how best to manage your diabetes for better health and vitality.

And remember: Use your free prescription discount card any time you go to the pharmacy. You don’t want to miss out on potential savings.

Additional sources:
Diabetes overview: NIH National Institute of Diabetes and Digestive and Kidney Disease
Using insulin to manage blood sugar: Mayo Clinic
Insulin resistance: NIH National Institute of Diabetes and Digestive and Kidney Disease