You might be reading this because your doctor has recommended starting you on insulin treatment. We aim to provide you with essential information about insulin and address any questions you may have about its use.
You may have been diagnosed with Type 1 Diabetes. In Type 1 diabetes, the body is unable to produce insulin, so insulin needs to be replaced through injections.
If you have Type 2 Diabetes, you may have previously achieved blood sugar targets with diet, exercise, and non-insulin medications. However, over time, your body will produce less insulin. Eventually, many individuals with Type 2 diabetes require insulin therapy to keep their blood sugar levels stable.
For some individuals, insulin therapy may be recommended right from the time of diagnosis based on their unique situation. Sometimes, because the body does not produce enough insulin, oral medications will be ineffective at maintaining blood sugar levels within the target range, making insulin injections necessary.
Insulin is a hormone produced by your pancreas that helps regulate blood sugar levels. After you eat, your body turns carbohydrates into glucose, which enters your bloodstream. Insulin acts like a key, allowing sugar to enter cells and be used for energy. This process helps to lower blood sugar levels.
Taking insulin can improve your life in several meaningful ways. Many people find that achieving target blood sugar levels helps them feel more energetic and better able to participate in daily activities. If your blood sugar levels are very high, starting insulin can relieve symptoms such as tiredness, persistent thirst, and frequent urination.
Additionally, insulin therapy helps you better manage your blood sugar levels, reducing the risk of serious complications in the future. While it requires some initial adjustment, insulin therapy has the potential to enhance your overall well-being and quality of life.
There are many types of insulin available in Singapore. They are different in terms of how quickly they start acting (onset of action), and how long their effect lasts (duration of action).
Your healthcare team will work with you to select the right type and combination of insulin that best fits your individual needs and lifestyle. This will take into consideration your health condition, daily routines, eating habits, activity levels, and overall health goals.
Types of insulin available in Singapore -
| Types of insulin | Onset of Insulin Action | How is it administered? | Duration of insulin action |
|---|---|---|---|
| Rapid-acting insulin | 10 - 20 minutes | Taken with a meal | 3 - 5 hours |
| Short-acting insulin | 30 minutes | Taken before a meal | 6 - 8 hours |
| Intermediate-acting insulin | 2 - 3 hours | Taken once to twice a day | 13 - 16 hours |
| Long-acting insulin | 2 - 4 hours | Taken once a day | 24 hours |
| Ultra long-acting insulin | 6 hours | Taken once a day | More than 24 hours |
| Pre-mixed insulin (mixture of rapid/short-acting and intermediate/long-acting insulin) | 10 - 30 minutes | Taken twice a day before meals | 18 to 24 hours or longer |
When you are started on insulin, your healthcare team will provide you with:
Having an insulin regimen personalised to your unique situation can optimise blood sugar control while allowing for flexibility and maintaining quality of life. Your healthcare team will support you throughout the process of starting insulin treatment. They will also help monitor your condition and adjust your insulin dose as needed.
Each person's insulin needs are unique and personalised. The amount of insulin required and the number of injections per day can vary based on several factors specific to your situation. These include the type of diabetes you have, your daily routines and eating patterns, how long you have been living with diabetes, and whether you also take any oral medications to help manage your blood sugar levels.
Some individuals may need just one injection of long-acting insulin per day, while others might require twice-daily premixed insulin. Additionally, some people may need a combination of long-acting insulin once a day and quick-acting insulin before meals.
It is common to have questions when starting insulin treatment. Here are answers to some frequently asked questions:
As you start insulin treatment, your healthcare team will guide you on how to administer insulin using either an insulin pen or a vial and syringe. With practice, you will become more confident and comfortable with the injection process.
Instructions on injecting insulin -
Insulin should be injected into subcutaneous (fat) tissue just below the skin, not into muscles. The best site for injecting insulin is the abdomen, as insulin absorption is fastest and most consistent there.
Always use a new needle with each injection to avoid scarring and risk of infection.
Rotation of the injection site
Credit: Image from Diabetes Hub NDRM
Insulin treatment may cause some side effects. Understanding these potential effects and knowing how to manage them can help you stay on track with your treatment.
Hypoglycaemia (Low blood sugar)
Low blood sugar, or hypoglycaemia, occurs when your glucose levels drop below 4.0 mmol/L. For more information on how to recognise and treat hypoglycaemia, as well as when to seek immediate medical attention, click here.
Low blood sugar can occur while on insulin if you:
For tips on how to prevent hypoglycaemia, click here.
If you experience frequent episodes of low blood sugar, it is important to consult your healthcare team quickly. Together, you can reassess your insulin regimen and adjust the dosage or timing of your medications as needed.
Skin changes at injection site
Repeatedly injecting insulin in the same spot can cause lumps to develop under the skin, which can reduce insulin absorption. To avoid this, use a different injection site for each dose. Before injecting, inspect and feel the area to ensure there are no lumps or skin changes. If you find any lumps, choose a different injection site.
Weight gain
Insulin treatment can sometimes lead to weight gain because it may result in consuming more calories than needed, with the excess converted to fat. However, it is possible to maintain a healthy weight while on insulin. Do not skip your insulin doses due to concerns about weight gain, as this can lead to harmful high blood sugar levels.
To manage weight gain while on insulin, consider the following strategies, and discuss them with your healthcare provider:
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