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JAMA Patient Page |

Starting Insulin Treatment for Diabetes FREE

Jill Jin, MD, MPH
JAMA. 2014;311(22):2347. doi:10.1001/jama.2014.5826.
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In people with type 2 diabetes, the body does not use insulin properly and, over time, cannot make enough insulin. Some people with type 2 diabetes will need treatment with insulin.


Diabetes is a condition that causes high blood sugars. Diabetes affects long-term health in many ways. It can affect the heart, kidneys, and vision if it is not well controlled. When pills and other medications are not enough to control diabetes, insulin treatment is the next step. Insulin is usually injected under the skin with a small needle. Injections are needed at least once a day and sometimes multiple times a day (such as after each meal). Sometimes an insulin pump is needed for continuous delivery of insulin into the body.


Many patients are worried or scared about starting insulin. Some do not want to start insulin until it is “absolutely necessary.” This can mean delaying the start of insulin treatment from when a doctor would have otherwise recommended it. Some of the reasons patients do not want to start insulin include

  • Fear of needles and having to do daily injections

  • Fear of weight gain

  • Fear of low blood glucose

  • Feelings of personal failure in controlling diabetes

  • Concerns about complicated regimens that will disrupt day-to-day life

These concerns are understandable. But it is important to know that none of these concerns are as serious as the complications of poorly controlled diabetes. Insulin treatment is like any other life change that you make for the sake of your health: it may not be the easiest to adopt, but eventually it will do you good.

Talk to your doctor about any concerns you might have about insulin. This conversation is very reassuring to most patients. Some things your doctor might tell you include

  • Current “ultrafine” needles are very thin and nearly painless. There are also pen injections available in which the needle is hidden so you don’t have to see it.

  • There is usually a small amount of weight gain after starting insulin treatment. If weight gain is a major concern, certain types of insulin can be chosen that cause less weight gain than others.

  • A low blood glucose level that is a serious concern happens very rarely with insulin injections (about a 2% risk, and even lower with certain kinds of insulin).

  • Starting insulin is in no way a sign of personal failure in controlling diabetes. Diabetes is by nature a progressive disease. The longer someone lives with diabetes, the more likely he or she will need insulin treatment.

  • There are many different options for insulin regimens. They can be changed to suit your needs. It takes some time to get used to taking insulin, but after a while most people would say it has very little effect on day-to-day life. Talking to someone who has been taking insulin for a while may help as well.

In the June 11, 2014, issue of JAMA, a review article discusses all aspects of insulin treatment for diabetes, including some barriers to starting insulin.

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To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.


The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

Source: Marrero DG. Overcoming patient barriers to initiating insulin therapy in type 2 diabetes mellitus. Clin Cornerstone. 2008;9(2):63-70.

Topic: Diabetes Care



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Spanish Patient Page: Comenzar el tratamiento con insulina para la diabetes

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