Page 19 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

SA JOURNAL OF DIABETES & VASCULAR DISEASE
VOLUME 9 NUMBER 4 • NOVEMBER 2012 161
Patients as Partners
LEARNING TO LIVE WITH INSULIN:
HELPING PATIENTS TO DO WELL
S Afr J Diabetes Vasc Dis 2012;
9: 161–163
Sandra Waddingham
Diabetes Co-ordinator North Lancs PCT Starting on insulin injections represents a
major change for most people with diabe-
tes. Many aspects of everyday life will need
to be considered more carefully, which can be quite
daunting. With adequate support and education from
the practice nurse, patients can be encouraged to be
proactive and positive towards this new stage in their
lives. This article looks at people with type 2 diabetes
or those with stable type 1 diabetes, who are likely to
be managed in general practice. We discuss everyday
concerns about using insulin, why people on insulin
are prone to put on weight, how exercise affects blood
glucose levels, how to manage illness in those with di-
abetes and how to adequately prepare for holidays.
Going on to insulin therapy can pose a range of
challenges, but adequate education can ensure that
patients with diabetes are ready to cope. Practice
nurses can make a real difference in this, making
sure that people have correct information on insu-
lin. Many people with diabetes, having spoken to
friends and acquaintances about insulin therapy, are
aware that people on insulin often gain weight. In my
experience, the risk of weight gain can even deter
some patients from starting on insulin. While some
concern is justified, it is imperative that glycaemic
control is optimised and careful explanation by the
practice nurse will help patients to understand and
avoid any unnecessary weight gain.
There are two possible reasons why people gain
weight on insulin. First, if a patient needs insulin then
their blood glucose levels will be high. Once insulin
is injected and absorbed into the blood stream, blood
glucose is lowered as insulin converts glucose into
energy. The energy is then either used or stored as fat
or glycogen. Therefore, if food consumption and exer-
cise levels remain exactly the same as before insulin
was introduced, then the patient will gain weight. Con-
versely, as glycaemic control deteriorates and glucose
is not converted into energy, weight loss and tiredness
are experienced alongside hyperglycaemia.
The second reason for weight gain is that insulin
is known to stimulate the appetite. Considering this
with the insulin resistance typical of type 2 diabetes
means that patients will have an excess of insulin in
their bodies, which they are unable to use efficiently.
Therefore, they are more likely to feel hungry, encour-
aging them to eat more, which then leads to weight
Originally in Br J Prim Care Nursing
2009