On Pens and Needles: What you Need to Know about Injectable Diabetes Medications

By Etie S. Moghissi, MD, FACP, FACE

Have you been told that you need to start an injectable diabetes medication? Are you afraid to even think about it? Are you thinking that injections are painful, inconvenient, and those needles are really scary? Plus, what might others think if they see you inject? Are you worried about what it means to need insulin injections? Do you know people who started insulin and ended up with other problems?

This is all understandable, and you are not alone. The truth is that there is a lot of confusion and misunderstanding about injectable medications, such as insulin or other kinds of medication.

Why Insulin?

Many people with diabetes believe that insulin therapy means that their condition is worsening or they consider it as a personal failure. They are afraid of low blood sugar and weight gain, or that their injection may be painful. It is important to know that one of the main problems of diabetes is that the pancreas does not produce enough insulin. Insulin is the natural hormone that is needed to keep blood sugar under control, and only insulin can replace insulin! So you may ask, “Who needs insulin?” All persons with type 1 diabetes need insulin to survive, and many people with type 2 diabetes eventually need insulin to control their blood sugar. And, many pregnant women with diabetes, or who have diabetes during pregnancy, need to be on insulin for a healthy baby. The bottom line is that insulin can be lifesaving for many people with diabetes.

Yes, insulin therapy can be associated with low blood sugar and weight gain if you are not careful with your meal plan and your physical activity. Newer insulins have a lower rate of hypoglycemia [hy-po-gly-SEEM-ee-ah] (low blood sugar) than older insulins. Also, newer insulin delivery devices (such as insulin pens) are more convenient than the traditional insulin vial and syringes.

If you have been told that you need to start insulin, or if you are already taking insulin, you should know about the insulin pens. They give accurate doses, are very convenient (can be carried around in your pocket or purse), and are covered by many insurances and prescription plans. The pen needles are so thin and so small that they are almost pain free. To get over being scared of needles and injections, you should give your first insulin injection into the skin of your abdomen (belly) or thigh while you are in your health care provider’s office. You will see for yourself that the pain of the injection is nowhere close to the pain of finger sticks that you do all the time to test your blood sugar. The reason for less pain is that there are far less pain fibers in the skin of your abdomen and thighs than there are in your finger tips. So, there is no need to live in fear. Experience the first injection in the safety of your health care team’s presence.

To avoid experiencing low blood sugar, learn to prevent it in the first place. You should monitor your blood sugar and you should not skip meals. Know what to do with the amount and the timing of your insulin injections relative to your physical activity.

The New Injectable Diabetes Medications That Are Not Insulin

There is a new class of diabetes medications (called incretins [in-KREE-tins] or gut hormone-like) that need to be injected but are not insulin. These medications stimulate your own body to make insulin to keep your blood sugar under control. The good news about this new class of medication is that they almost never cause low blood sugar (hypoglycemia) by themselves. The better news is that they actually can lead to weight loss instead of weight gain. They are easier to use because they are all administered by pen injectors, which are almost pain free, and can be carried around. Currently, there are 2 types of these medications available, exenetide [ex-EN-ah-tide] (Byetta) and liraglutide [lir-AH-gloo-tide] (Victoza). And, more are on the way.

Another injectable medication for diabetes is pramlintide [PRAM-lin-tide] (Symlin) which is used with insulin to control post-meal blood sugar and is also taken with a pen injector. In summary, only you and your health care team can decide which medication is right for you. Remember that these are tools to help you get you to your blood sugar goals. You should focus on your goal (optimal blood sugar control). The goal is the most important. How to get there may be less important. Work with your health care team to find the right option for you. For some people, the best option may be pills. For others, the best option might be an injection. Do not let fear or false ideas prevent you from reaching your destination! (Your good health!)

Dr. Etie Moghissi is board certified in endocrinology, diabetes and metabolism and is in private practice in Marina del Rey, California. She is a Clinical Associate Professor of Medicine at UCLA. Dr. Moghissi is a recognized expert in the field of diabetes and is actively involved in direct patient care, as well as in professional medical education. She has published in peer-reviewed medical journals including Endocrine Practice and Diabetes Care. She serves as Treasurer of the American Association of Clinical Endocrinologists, and is Secretary/Treasurer of the American College of Endocrinology.