10 Ways You May Be Sabotaging Your Insulin Therapy

This content originally appeared on Everyday Health. Republished with permission.

By Diana Rodriguez

Medically Reviewed by Elise M. Brett, MD

For many people with type 2 diabetes, insulin therapy is a must, and there can be serious consequences for those whose insulin isn’t working correctly.

In type 2 diabetes patients, the pancreas doesn’t make enough insulin and the body doesn’t respond well to the insulin it does produce. Injecting insulin can help the body better use glucose (sugar) in the blood or store it for later use, keeping your blood sugar in a healthy range and helping to prevent serious health problems.^[1]

“Generally, as the disease progresses, most patients with type 2 diabetes will end up on insulin at some point,” says Jesse Vander Heide, RN, CDCES, a certified diabetes educator at the Oregon Health and Science University in Portland. Your doctor may consider factors such as your current treatment regimen, blood sugar levels, and target glucose goals when advising if insulin therapy is right for you.

If your doctor prescribes insulin to help you manage type 2 diabetes, they will work with you to determine the type of insulin and insulin delivery method that’s best for you. There are different types of insulin available, and they vary in how fast they start to work, when they peak, and how long they last.

People with type 2 diabetes need a combination of two insulin types: basal (long-acting) insulin, which helps control blood glucose levels overnight and between meals, and bolus (rapid-acting) insulin, which helps prevent a rise in blood sugar following meals.^[2]

Usually, people take basal insulin once or twice a day at about the same time. Whether that’s in the morning or at night depends largely on what works best for your lifestyle. No matter when you take it, the crucial element is consistency, Heide says.

“We tend to cater the timing more toward what the person has an easier time remembering,” Heide says. “But there are instances in which we have to adjust based on what blood sugar is doing.”

Bolus insulin is taken at mealtimes to help prevent your blood sugar from spiking. Rapid-acting bolus insulin begins working about 15 minutes after injection.^[3]

It has been commonly recommended that people with type 2 diabetes receive half their insulin as basal and half as bolus. That said, research from 2023 suggests that this fifty-fifty ratio of basal to bolus insulin is not the optimal treatment strategy for most type 2 diabetes patients. The researchers indicate that patients need personalized insulin ratios that are likely to change over time.^[4]

Your healthcare team can help you settle on a combination of insulin types that works best for you. New types and formulations of insulin are constantly being introduced, Heide says. These newer insulins can more closely match the function of a normal pancreas.

How and where you inject any type of insulin can make a difference, too. In the past, most people injected insulin using a vial and syringe. Now there are way more options for insulin delivery, including disposable or refillable insulin pens, insulin pumps that administer insulin throughout the day based on meals and blood glucose readings, and rapid-acting insulin inhalers that can be used in conjunction with an injectable long-acting insulin.^[5]

Some of these methods even come with apps to calculate and track your dosing over time.^[6]

According to experts, improperly injecting insulin can affect blood sugar levels and the effectiveness of insulin.^[7]

Other mistakes or bad practices can also get in the way of your efforts to keep the condition well controlled, says Ava Port, MD, an endocrinologist for MedStar Health in Washington, DC. Ask your healthcare team for tips and strategies that make the most sense for you and your insulin regimen. And if you’re concerned that your insulin is not working correctly, avoid these common insulin mistakes to make sure you’re getting the most out of your treatment.

1. Forgetting Blood Sugar Checks

Checking your blood sugar levels regularly helps you stay tuned in to how your body responds to your medications, food, and lifestyle habits, Dr. Port says. It can help you and your doctor determine the right amount of basal and bolus insulin to take. Fasting blood sugar levels reflect how basal insulin works in the background, whereas pre-meal and evening blood sugar levels are a better barometer of how the bolus insulin dosing matches up with your food and carbohydrate intake. Many people don’t check their blood sugar when they feel fine, Port says. Or, despite having symptoms of high or low blood sugar, they simply ignore the fact that their diabetes may be out of control, she adds.

Smart strategies to stay on top of your blood sugar testing routine include choosing a glucose meter that works for your lifestyle, keeping the meter where it’s easy to get to and use, and finding ways to remind yourself to do the checks. It can be a note on your refrigerator, an alarm on your phone, or some other device that prompts you to use it — whatever works for you. These days, most people taking insulin use a continuous glucose monitor, a special device placed just under the skin that tracks blood sugar readings continuously and sends this information to a reader or phone app. Most devices can typically be worn for up to 7 to 14 days, depending on the brand.

2. Missing Insulin Doses

If you have type 2 diabetes and miss a dose of basal or bolus insulin, your blood sugar will rise. It can be tough to always remember to take your insulin, especially when you’re busy at work or school. But it’s incredibly important. Make it a priority, Port advises. Since basal insulin is generally taken just once a day, pick a time that works for you, such as just upon waking in the morning, and make it part of your routine. Keep your insulin supplies next to the alarm clock, in among your makeup supplies, or next to your shaving cream: wherever you’ll see it and won’t ignore it.

If you take bolus insulin, try keeping an extra set of your insulin supplies at work or in a bag you carry with you, so that medication is always in easy reach when you need it. Set an alarm on your phone, or find some other way to remind yourself to stop and take the insulin the prescribed amount of time before eating, Heide says. Support programs and groups for people with type 2 diabetes can be excellent places to pick up tips on remembering to take your insulin. The American Diabetes Association (ADA) has a directory of endorsed support programs, and the Defeat Diabetes Foundation has a directory of local support groups by state. Sometimes involving another person can also help build the medication into a routine, says Heide.

3. Skipping Meals

There are different types of insulin to treat diabetes. If you take rapid-acting bolus insulin and forget to eat, or eat less than you thought you would, your blood sugar level can get dangerously low, Port says. “Even though rapid insulin should be taken before meals, if someone is unsure of when or how much they will eat, it may be safer to wait until immediately after eating to take the rapid insulin,” she suggests. Talk to your doctor about whether this strategy may be right for you, however.

But also keep the big picture — and weight control — in perspective, Port cautions. “You shouldn’t go out of your way to eat just to take your bolus insulin if you aren’t hungry,” she says. If a meal is skipped, the rapid-acting dose should typically also be skipped. “And on that same note, if you are ravenous and needing to eat frequently just to keep your blood sugars up, you should probably talk to your doctor about whether your insulin doses need to be reduced,” Port adds.

An approach that works for some people is to start the day thinking of the food patterns you’re going to follow for a given day and week, such as a big breakfast followed by a light lunch, and an even lighter dinner. Or the reverse. Doing this can help you formulate, and plan for, meals that will require bolus insulin injections at more predictable times of day. Counting carbohydrates is another diabetes and blood sugar management tool. Many of those who take bolus insulin need to count carbs to dose their insulin correctly. There are several methods to count carbs, and the ideal number of carbs per meal can be very different from person to person.^[8] If carb counting is necessary, work with your care team to find the ideal number of carbs and counting method for you.

4. Making Unhealthy Food Choices

“People with diabetes should limit sugary foods, such as juice, soda, or candy, to only when they are treating low blood sugar,” Port says. Foods high in sugar or refined carbohydrates, and sugary drinks, will quickly raise blood sugar levels and won’t match up with a bolus insulin dose that’s been measured for you based on eating meals of a similar size and carbohydrate content throughout the day.

Make it a habit to choose less processed sources of carbohydrates, such as fresh fruit, vegetables, beans, and whole grains, and balance out your meals with lean protein and healthy fats to help keep your blood sugar stable. One way to think about healthier foods and cut back on carbs, Port says, is to choose those that come from the earth or the ground and haven’t been processed much. “I like to use the example of eating an apple [healthy] versus eating applesauce, or even drinking apple juice [less healthy]. The closer you can get to the simple apple, which isn’t processed at all, the better.”

Keeping a food journal can help you and your doctor look for patterns and understand how your food choices are affecting your blood sugar.

5. Managing Stress and Mental Health

Stress and mental health can also play a big role in your blood sugar level. Stress, for example, triggers the release of the hormones cortisol and adrenaline, which can make it harder for insulin to work properly.^[9] Port says this means the same dose of basal or bolus insulin can actually be less effective if you’re stressed out.

Research from 2023 also suggests that mental health conditions like anxiety and depression may increase the risk of developing type 2 diabetes and may also be correlated with poorer blood sugar control and a higher risk of diabetes complications.^[10]

Try to identify the stressors and sources of chronic anxiety in your life. Then look for a relaxation technique that works for you. Talk to your doctor for ideas. Get consistent sleep. Listen to music. Turn off all devices at night, Port recommends. If possible, make time each day to destress — take a yoga class, do deep breathing exercises, set aside time to read a book or relax with friends, or establish a soothing bedtime routine to help you wind down.

6. Limiting Yourself to Aerobic Forms of Exercise

Any and all exercise is good for your health, stresses Port. Aerobic exercise is great for your heart and your waistline, for example. Weight-lifting and other muscle-strengthening exercises have a role to play, too, she says. “Performing resistance exercise regularly helps to build and maintain lean muscle mass, which in turn improves sensitivity to all types of insulin,” Port says. And you don’t even have to join a gym or lift heavy weights to get great benefits. Strengthen muscles at home with push-ups, hand weights, or simply walking up and down a flight of stairs repeatedly.

That said, exercise can lower blood sugar too much, leading to hypoglycemia and requiring your insulin and carbohydrate intake to be adjusted as a result. It’s important to check blood sugar levels before, during, and after exercise to avoid hypoglycemia.^[11] Work with your care team to make sure your exercise regimen and treatment plan can work cohesively to manage your diabetes and keep your blood sugar levels within a safe range. In addition, people with diabetes who previously lived a sedentary lifestyle should always check with their doctor to ensure that beginning an exercise program is safe for their heart.

7. Smoking Cigarettes

Not only can smoking increase the risk of developing type 2 diabetes, it can make it harder to manage the condition and find the right dosage of insulin.^[12] “Smoking raises blood sugars acutely, but it also affects blood sugars by causing chronic inflammation and insulin resistance,” Port says. Researchers are looking into the link between e-cigarettes (vaping) and diabetes. In addition, those with type 2 diabetes are at higher risk of heart attack and stroke, and smoking only increases that risk. If you use tobacco in any form, work with your doctor to come up with a plan to help you kick the habit.^[13]

8. Not Drinking Enough Water

It’s not just what you eat, but also what you drink — or don’t drink — that can change the effectiveness of insulin. “Staying hydrated by drinking lots of water helps your kidneys flush out extra sugar floating around in your bloodstream,” Port says. “It also helps medications like insulin work better by helping to maintain good blood flow — so the medicine can reach the tissues and cells where they’re needed most.” To remind yourself to drink water throughout the day, carry a refillable water bottle around with you. Use it a lot. And skip the sports and performance drinks, says Port, since they usually just give you more sugar.

9. Being Overweight

Losing unhealthy pounds can help improve your body’s sensitivity to insulin. And you don’t need to lose a lot to start seeing results. Dropping just 3 to 7 percent of your body weight can help improve your blood sugar and control your diabetes.^[14] “Many individuals find it difficult to lose weight without professional help,” Port says. Look for help from your doctor, a registered dietitian, a weight loss program, a therapist, or a personal trainer. And look into phone apps like MyFitnessPal and Lose It! and other technologies to help you manage your calorie intake, level of activity, and more.

10. Always Choosing the Same Spot to Inject Insulin

Insulin is absorbed at different rates depending on where you inject it. It enters your blood fastest when you inject it into the fat of your abdomen, a little more slowly when you inject it into the upper arms, and even more slowly when you inject it into the thighs and buttocks. You’ll get the best results by injecting your basal or bolus insulin into the same general body area, but rotating the side of the body where you inject it from day to day. Injecting insulin in the same spot over and over can cause hard, fatty lumps to form. These lumps reduce the effectiveness of injected insulin.^[15] “You could be injecting your usual dose of insulin into one of these areas — but potentially 50 percent or less of the insulin is absorbed,” Port says. She recommends checking for these hard lumps from time to time.

For more on how to use insulin properly, check out Diabetes Daily’s article “How to Use Insulin.”

Editor’s Note: Lose It! is owned by the Everyday Health Group.

Editorial Sources and Fact-Checking