If you take insulin for type 2 diabetes, chances are you’ve already tried lifestyle changes like diet and exercise. You’ve likely also already taken an oral medication like metformin (such as Glumetza or Glucophage). Insulin may be the next step your doctor will recommend to get your diabetes under control.
Taking daily insulin is a supplement to the hormone either your pancreas doesn’t make enough of or your body doesn’t use efficiently. But what if even insulin shots don’t bring your blood sugar within range? If you’ve been on insulin for a while and it doesn’t seem to be working, it’s time to see your doctor again to reevaluate your treatment plan.
Here are three recommendations your doctor might make to help you gain better control over your blood sugar levels.
Step 1: Increase your insulin dose
The dose of insulin your doctor initially prescribed might not be high enough to control your blood sugar. This is especially true if you’re overweight, because excess fat makes your body more resistant to the effects of insulin. You may need to take extra injections of short- or rapid-acting insulin each day to get your blood sugar within range.
Your doctor may also change the type of insulin you take. For example, you might add a dose of fast-acting insulin before meals to adjust for blood sugar swings after you eat, or add long-acting insulin to control your blood sugar between meals and overnight. Switching to an insulin pump, which delivers insulin continuously throughout the day, can help keep your blood sugar steady with less work on your part. However, this is mostly used by those with type 1 diabetes.
To make sure your new insulin dosage is keeping your blood sugar in the right range, you may need to test your levels two to four times a day when you’re adjusting your dose. You’ll typically test while fasting, and before and a few hours after meals. Write down your readings in a journal, or keep track of them using an app like mySugr or Glucose Buddy. Let your doctor know if you develop low blood sugar. You might have overcompensated by taking too much insulin, and you’ll probably need to lower the dose slightly.
Taking more insulin can help you achieve better blood sugar control. Yet it can have downsides too. For one thing, you might gain weight, which is counterproductive to diabetes control. Having to give yourself more injections each day can also make you less likely to stick with your treatment. If you’re having any side effects or you have trouble sticking to your treatment plan, ask your doctor or a diabetes educator for advice.
Step 2: Reevaluate your diet and exercise program
The same healthy diet and exercise programs you started when you were first diagnosed with diabetes are worth revisiting now — especially if you’ve let them lapse. The diabetes diet isn’t all that different from a normal healthy diet. It’s high in fruits, vegetables, whole grains, and lean protein, and low in processed, fried, salty, and sweet foods.
Your doctor might also suggest that you count carbs so you know how much insulin to take. If you’re having trouble sticking to a diet, a dietitian or diabetes educator can recommend a plan that suits both your taste preferences and your blood sugar goals.
Exercise is the other critical part of blood sugar control. Walking, bike riding, and other physical activities help lower your blood sugar directly, and indirectly by promoting weight loss. Experts recommend that you get at least 30 minutes of aerobic exercise on five or more days a week. If you’re overweight, you might need to increase it to 60 minutes a day. Ask your doctor how to balance your insulin doses with exercise so your blood sugar doesn’t dip too low during workouts.
Step 3: Add an oral drug — or two
Combining insulin with one or more oral drugs can help you gain better control over your diabetes than either treatment alone, as research shows. Most people continue to take metformin in addition to insulin. It offers the advantage of minimizing weight gain compared to taking insulin alone.
Alternately, your doctor might add one of these medications to your insulin.
- glyburide (DiaBeta, Micronase)
- glipizide (Glucotrol, Glucotrol XL)
- glimepiride (Amaryl)
- pioglitazone (Actos)
- rosiglitazone (Avandia)
Glucagon-like peptide-1 (GLP-1) receptor agonists:
- dulaglutide (Trulicity)
- exenatide (Byetta)
- liraglutide (Victoza)
Dipeptidyl peptidase-4 (DPP-4) inhibitors:
- alogliptin (Nesina)
- linagliptin (Tradjenta)
- saxagliptin (Onglyza)
- sitagliptin (Januvia)
Keep in mind that any new drug you take can have side effects. For example, some can lead to weight gain, others can help with weight loss, and some increase your risk for heart failure.
Before you add any new drug to your insulin regimen, ask your doctor these questions:
- Why are you recommending this medication?
- How will it help improve my diabetes control?
- How do I take it?
- How often should I test my blood sugar once I start on combined therapy?
- What side effects might it cause?
- What should I do if I have side effects?
You might have to play around with insulin, oral medications, diet, and exercise to get your blood sugar level into the right range. Keep in touch with your doctor regularly, as they can monitor your progress and help you make the adjustments needed to get your blood sugar under control.