When you hear the word “insulin,” do you picture giant needles (ouch!) or pop culture portrayals of insulin users with low blood sugar (like Julia Roberts losing it in Steel Magnolias)?
Either way, most people think of insulin as a difficult, painful, or potentially scary medical treatment.
The problem is that if you have type 2 diabetes, you need to know the real deal before you can make an informed choice about whether or not this potentially lifesaving therapy is right for you.
Here, we take a look at the facts and fiction about insulin when it comes to treating type 2 diabetes.
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Diabetics always need insulin
Not necessarily. People with type 1 diabetes (about 5 percent to 10 percent of diabetics) do need insulin. If you have type 2, which includes 90 percent to 95 percent of all people with diabetes, you may not need insulin.
Of adults with diabetes, only 14 percent use insulin, 13 percent use insulin and oral medication, 57 percent take oral medication only, and 16 percent control blood sugar with diet and exercise alone, according to the CDC.
The point is to get blood sugar—which can be a highly toxic poison in the body—into the safe zone by any means necessary.
Taking insulin means you’ve ‘failed’
“This is a big myth,” says Dr. Jill Crandall, professor of clinical medicine and director of the diabetes clinical trial unit at the Albert Einstein College of Medicine, in the Bronx, N.Y. “Many people who try very hard to adhere to a diet, exercise, and lose weight will still need insulin.”
The fact is that type 2 diabetes is a progressive illness, meaning that over time you may need to change what you do to make sure your blood sugar is in a healthy range. Eating right and exercise will always be important, but medication needs can vary.
“A large percentage of people with type 2 diabetes will ultimately need insulin, and we don’t see it as a failure,” she says.
Insulin injections hurt
“This is absolutely false,” says Crandall. “With the small fine needles we have today, insulin injections are close to painless, if not painless.”
In fact, most people would say that the finger pricks used to measure blood glucose levels hurt more than insulin injections.
“When people get their first injection, they often say, ‘I can't believe it didn’t hurt,’” says Crandall. What’s more, you may not need to use syringes at all.
There are injector pens on the market that allow you to dial the dose of insulin, snap on a tiny needle, and inject painlessly. Really.
Insulin can cause dangerously low blood sugar
Okay this one is possible, but not likely. People with type 2 diabetes tend to be at lower risk of hypoglycemia (low blood sugar) than those with type 1.
A prolonged episode of low blood sugar could cause a loss of consciousness or coma. Still, most people with type 2 can easily recognize the symptoms, which include anxiety, shaky hands, sweating, and an urge to eat.
Consuming a bit of sugar—a few Life Savers, diluted juice, or glucose tablets—quickly reverses the low blood sugar.
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Insulin is forever
Not necessarily. Some people with type 2 diabetes may need insulin temporarily, such as right after they’re diagnosed or during pregnancy, whereas others may need to stay on it indefinitely.
Some people who lose a lot of weight (naturally or with the help of bariatric surgery) may find that they no longer need insulin, while others who lose weight may still need it.
(It largely depends on how much damage diabetes has done to the insulin-producing cells of the pancreas.)
“It is not always a one-way street,” Crandall says.
Insulin is difficult to take
Gone are the days when insulin injections were bulky, conspicuous, and difficult to administer.
“Today, insulin comes in pen injectors that are easy to carry with you, don’t require refrigeration, and can be used discreetly, often just once a day,” Crandall says.
“There are a large variety of insulin and insulin regimens that are much more convenient than they used to be,” she adds.
Oral medications are better than insulin
Oral diabetes medications can be great when it comes to lowering blood glucose levels. Many have been used for years and are very safe, such as metformin.
Still, they don’t work for everyone. "For some people, insulin is the easiest and best because it always works, but some people respond to pills, and others don’t," says Crandall.
Not all oral medications have a tried-and-true safety record. For example, Avandia was restricted by the FDA because of research suggesting that it ups the risk of heart attack.
Insulin will make you gain weight
There’s some truth to this one. Some people with type 2 diabetes may gain weight after starting insulin therapy.
However, the insulin therapy itself does not induce weight gain. It’s because if a diabetes treatment is working, the body begins to process blood glucose more normally, and the result can be weight gain. (This is one reason unexplained weight loss can be an early symptom of diabetes.)
The good news is that this tends to level out as insulin therapy continues, and the weight gain may be transient, explains Crandall.
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People with type 2 don’t make insulin
This isn’t true. People with type 2 diabetes may actually produce higher-than-normal levels of insulin earlier in the course of the disease, a condition known as hyperinsulinemia.
This happens because type 2 diabetes is caused by insulin resistance, a condition in which the body loses the ability to respond normally to the hormone.
Taking insulin shots can help overcome insulin resistance, and they can take the place of naturally occurring insulin production, which does tend to dwindle over time.
Insulin means your diabetes is “serious”
The truth is diabetes is a serious condition no matter how you treat it—it’s just that so few people realize it. Because you can have diabetes and feel just fine (or ignore symptoms like thirst and fatigue), you may think you’ve got a “touch of sugar” or some other mild-sounding condition.
In reality, high blood sugar poisons the body, damaging the heart, kidney, eyes, and nerves.
The point is to make sure your blood sugar is under control, whether it takes diet, exercise, pills, insulin, or all of these combined.
Insulin use requires multiple daily injections
Not always. If you need insulin, you have options. You can try a long-acting once-a-day insulin (usually given at night), which mimics the low level of insulin normally found in the body all day long.
This may be enough to control blood sugar on its own, or it can be combined with oral medications.
If blood sugar is still too high after meals, however, you may need to take insulin several times a day, just before eating.
Insulin is a treatment of last resort
Although some people exhaust all possible diabetes treatments before resorting to insulin, this may not be the best strategy.
“By the time a person with type 2 starts insulin therapy, they likely already have diabetes-related complication because of poor blood sugar control,” Crandall says.
Because high blood sugar is so toxic and can up the risk of heart attack, stroke, and other problems, you shouldn’t waste too much time undergoing treatments that aren’t getting your blood sugar under control.
In fact, starting insulin sooner may avoid complications, cause oral medications to work better (and be effective longer), or allow you to use a less-complicated insulin regimen for a longer period of time.
This article originally appeared on Health.com.