Dear Dr. Arzinda,
I am a 45 year old diabetic patient. I was diagnosed 10 years ago, initially my sugar level was controlled with tablets, but last year my levels were un-controlled and my doctor switched me to insulin twice daily. There was good response in the beginning, but now it seems insulin is also not working for me. Even by increasing dose of insulin my sugar is not controlled. I assume insulin is the last treatment, if it is not working for me then I’m afraid I’m doomed. Can you help me solve my problem?
Insulin failure.
Dear Insulin failure,
First of all let me correct you that 
Insulin is not the last treatment; it is in fact the best treatment for diabetes. It should be started early rather than late before development of complications. Let us explore why this best form of treatment is not working in your case.
You are not the only one facing such a problem. A lot of diabetic patients go through this dilemma. Your problem is one of Crucial Accountability. You might be thinking your doctor is not competent enough or the insulin you are using is fake, But I think you should first of all hold yourself accountable, whether you are putting enough effort to control your diabetes. As you are the key team member of your diabetes care team, whereas your doctor, diabetes educator, dietician etc are there to guide and support you. You should hold yourself accountable here whether you are putting in every effort to make the insulin work? Patients usually think that once they are on insulin they are at liberty to eat anything at their will. This is not true. Even while using insulin you have to follow diabetic diet and exercise routine.
Let me remind you there are four important pillars of diabetes management, insulin is only one of them. The other three pillars are diet control, exercise and stress management. It seems that you are only working on one pillar right now. In this way you can only manage 25% of your diabetes. Along with insulin and medicines you have to control your diet as advised by your doctor/dietician. For that you have to maintain a food diary in which you write down everything you eat in a day, and then hold yourself accountable at the end of the day. Point out the mistakes you made while eating mindlessly, and then try not to repeat those mistakes the following day. Similarly exercise is very important part of diabetes management, you have to do at least 30 min of exercise or walk every day. You can start with 5 or 10 min and gradually increase the time of your exercise. Maintain an exercise log book where you can note down your time of exercise every day and then review it at the end of the week. Exercise helps to reduce weight, burn extra calories you gain from food and helps reduce insulin resistance, so your insulin will work better when you exercise regularly.
Another important step in diabetes management is stress reduction. If you are physically or mentally stressed due to any reason, stress hormones released in your body will release the stored glucose from your liver and your sugar level will go up despite taking insulin. So find out whether you have any hidden or obvious stressor disturbing you, then sit down and relax, learn and practice stress relaxation techniques. When you overcome stress, I can guarantee you your blood sugar level will drop down and your insulin dose will be reduced. You can learn stress management by attending diabetes sessions in Diabetic’s Institute Pakistan.
Another important reason for your insulin not being effective can be insulin resistance. Insulin resistance occurs when insulin is present but the receptors for insulin at the end organs are not effective or less in number. It occurs in obese patients. You haven’t mentioned your weight. If your weight is more than what is ideal for your height, you have to reduce weight in order to reduce insulin resistance and to reduce your dose of insulin. Regular exercise and proper diet can help you reduce weight.
Finally, check your Insulin injection technique, timing of injection in relation to meals, the temperature on which you store your insulin( keep it in a cool place but do not freeze), and check expiry date of you insulin.
I hope when you check all the points discussed here, you will find out one or two reasons why your insulin is not working. So hold yourself accountable before blaming it on your doctor or the insulin. By following these simple tips you will achieve ideal control of your diabetes.
Regards,
Dr. Arzinda Fatima.