Starting insulin: what to expect and common myths

Few words worry people with diabetes as much as “insulin”. Many people in India delay it for years because of fear, myths or advice from relatives. Yet insulin is simply the hormone your own pancreas makes. When your body cannot make enough, giving it back is one of the most natural and effective treatments in medicine.

Why might my doctor suggest insulin?

Your doctor may recommend insulin when:

• you have type 1 diabetes, where the body makes little or no insulin. Read type 1 diabetes in adults and LADA.
• your type 2 diabetes is no longer controlled with tablets or other injections, and your HbA1c stays above target
• your sugar is very high at diagnosis, with weight loss or symptoms. Insulin can bring it down quickly, and some people can later reduce or stop it under medical supervision.
• you are pregnant or planning a pregnancy and need tighter control
• you are unwell in hospital, having surgery, or on steroid medicines
• other medicines are not suitable because of kidney or liver problems

What are the common myths?

• “Insulin means my diabetes is at its last stage.” No. Type 2 diabetes changes over time, and many people need insulin at some point. It reflects how long you have had diabetes, not that you have done something wrong.
• “Once I start, I can never stop.” Not always true. In type 1 diabetes, insulin is lifelong. In type 2 diabetes, some people use it for a period and later move to other treatment. Your doctor decides this with you.
• “Insulin damages the kidneys or eyes.” It does not. High sugar damages them. People often start insulin late, when damage has already happened, which is where this myth comes from. Read does insulin damage the kidneys.
• “Injections are very painful.” Modern pen needles are very short and fine. Many people find the injection less uncomfortable than they expected.
• “Insulin is addictive.” It is not. It is a hormone your body needs, not a drug of dependence.

What does starting insulin usually involve?

Every plan is individual, and your doctor will choose the type and timing. Common approaches in type 2 diabetes start with a long-acting (basal) insulin once a day, while tablets often continue. Some people need insulin with meals as well, or a premixed insulin. In type 1 diabetes, a combination of basal and mealtime insulin is used from the start.

You will be taught how to use the pen or syringe, which body areas to use (usually the belly or thighs), and how to rotate sites so lumps do not form. Your doctor or diabetes educator will tell you how much to use and how to change it. Please do not adjust the amount on your own unless your doctor has given you a written plan for doing so.

You will usually be asked to check your sugar more often in the first weeks. A CGM sensor can make this easier.

Will I gain weight?

Some people gain a little weight after starting insulin, partly because sugar that was being lost in the urine is now being used by the body. Eating sensibly, staying active and choosing the right combination of medicines helps. Your doctor may combine insulin with other medicines that support weight control.

How do I recognise a low sugar?

Hypoglycaemia (low sugar) means a sugar below 70 mg/dL. It is the main side effect of insulin. Warning signs include:

• sweating, shaking or a pounding heart
• sudden hunger
• feeling anxious, irritable or dizzy
• headache, blurred vision or tingling around the lips
• confusion, odd behaviour or slurred speech in more severe cases

At night, a low may show up as nightmares, sweating through your clothes, or a morning headache. Common triggers are a delayed or missed meal, more exercise than usual, alcohol, or too much insulin.

What should I do if my sugar is low?

If you feel low, check your sugar if you can. If it is low, or you cannot check, treat it straight away with fast-acting sugar, then recheck.

The American Diabetes Association advises that glucose (15 to 20 grams) is the preferred treatment for a conscious person with blood glucose below 70 mg/dL. If monitoring 15 minutes after treatment still shows hypoglycaemia, the treatment should be repeated. Once glucose returns to normal, a meal or snack helps prevent it from dropping again. — Summarised from the American Diabetes Association Standards of Care in Diabetes 2026, Section 6 (Diabetes Care 2026, PMID 41358894)

In everyday Indian terms, fast-acting sugar can be glucose powder or tablets, sugar dissolved in water, or a small glass of fruit juice. Chocolates and biscuits work more slowly because of their fat. Your diabetes educator can tell you the right amounts. Carry a source of sugar with you at all times, and teach your family what to do. If you become confused or cannot swallow, family should not put food in your mouth and should get emergency help. Ask your doctor whether a glucagon rescue product is available and suitable for you.

Always tell your doctor about any low sugar. It usually means your plan needs to change.

How do I store and carry insulin?

Insulin is sensitive to heat, which matters in Indian summers. Read storing insulin in Indian heat.

What should I ask my doctor?

• Why do I need insulin now, and is it likely to be long term?
• Which insulin and device suit me, and when do I inject it?
• What sugar readings should I aim for, and when should I call you?
• What should I do if I get a low sugar, or if I am sick and cannot eat?

To discuss whether insulin is right for you, book a consultation.