Is it my fault that I have to take insulin now?

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Is it my fault that I have to take insulin now?

Dear Dr. Bev,

I have type 2 diabetes.  I exercise almost every day.  I eat less than I used to and I never skip my oral medication. Every time I check my blood sugar it's over 200mg/dL.   My doctor used to threaten me that if I didn't manage my diabetes better, and then I would have to take shots. My doctor says my A1C is too high. Now my doctor tells me that I need to start taking insulin.  Even though I've done everything right, I feel like such a failure.  I'm afraid of the needles!  I'm so upset, please help me.

Thank you,



Dear TA,

Thanks for your letter. I understand your resistance to start taking insulin.  What you are feeling is known as "Psychological Insulin Resistance."

First of all, you are not a failure! You are describing the natural progression of type 2 diabetes that involves the progressive loss of beta cell function. Oral medications alone will not be enough to control blood sugar, which means your need for insulin at this stage is not your fault. It is part of the aging process.  (Sorry, I didn't mean to call you "old"!) Most patients with type 2 diabetes will eventually need to take insulin to maintain control over their blood sugar.

Second of all, I'm very sorry that your doctor added to your frustration by making insulin therapy sound like a punishment. It is not! Repeating what I said one paragraph above: your need for insulin at this stage is not your fault.

Let's discuss your fear of needles - most often, patients with type 2 diabetes are started on a once daily long acting insulin injection. Have you seen what the needle looks like?  I can tell you from personal experience; the needles (for the insulin pen) are extremely small and very fine.  If you're worried about pain, it doesn't hurt! The once-daily insulin regimen is simple and easy. Please ask your diabetes educator or your doctor's nurse to show you the tiny needle and help teach you to do an injection on yourself.

What you can and can't control:  You can control your thoughts and your actions.  You can think about diabetes management in a rational way by accepting your transition to insulin therapy and recognizing that it's not your fault.  You can't control the beta cell failure. You can control making healthy food choices, eating reasonable portions, exercising, losing weight, taking your medications, managing stress, and visiting your doctor on a regular basis. Lastly, checking your blood sugar becomes an even more important part of your care. You will need to check more frequently when you first begin insulin therapy so that you and your doctor can make adjustments to your regimen.

Good luck!  Dr. Bev