“What does it feel like? Does it hurt?”
I guarantee that every insulin-dependent diabetic who manages his or her condition via pen injections hears this at least every so often. I was diagnosed with type 2 diabetes in 2010, and started insulin in 2012. I thought, prior to this point, that I was managing my diabetes with diet and exercise. I’d dropped 40 pounds since my diagnosis; my fasting glucose was often in the 120s, although inconsistent based on my diet. But my A1C steadily continued to climb.
When my summer 2012 bloodwork revealed an A1C of 11.5, we decided it was time for insulin. I didn’t know exactly what to think or feel; I’ve always been a textbook overachiever, down to the gold stars and unnecessary extra credit assignments. This felt like a failure, exacerbated by the wildly-fictional societal sentiment that, as a person of size (read: tall, big boned, and overweight) that this was a condition that I could vaporize by eating less and exercising more. That was a profound untruth, but I found myself soaking in the deep waters of shame because of it. Everything from the subtext of self-help magazine articles to the surly punchlines of low-talent late night hosts punctuated it: if you’re fat, it’s your fault, and diabetes is the codified form of punishment you can expect. I’ll be writing more on this in a later piece, I’m sure. For now, it was enough to add a deeply emotional barrier into this addition of multiple injections into my daily life.
From there, here’s what I WISHED had happened: I wish my medical team would have brought me in for training, not letting me leave the office until I had successfully completed an injection myself. But that’s not what happened, at all — I was brought in for training, sure, but it ended up being from a beleaguered nurse, at the end of what must have been a long day, who played me a 10-minute video and tossed a packet of information my way.
I left the office with three injectable medications in pen form: mealtime insulin, sustained release overnight insulin, and a exenatide injectable (prescribed to counteract some of the weight-gain side effects of insulin), plus a giant box of pen needles to screw onto the tips of these pens.
Me and needles: A hate story
At this point, I’d like to tell you something about myself. I. Hate. Needles. A lot. Whenever anything had pierced my skin in the past, I would freak out a little, and make a screaming noise unnatural to creatures besides very small dogs and very small children. It hadn’t been fun for me, and it hadn’t been fun for any medical professional on the other end of the injection.
Taking my blood sugar readings every morning over the years hadn’t lessened my strong dislike of the things, and let’s be honest: fingertip pricking is one thing, needles anywhere else is another.
So I headed home clutching the bag of needles from my pharmacy to my chest and slumped down on my couch. I visualized my life going forward as nothing from this part on but a barrage of needles, punctuated with occasional moments of anxiety about my lack of blood sugar control. That moment seriously depressed me; there I was, home alone with a bunch of drugs needed to maintain my health and livelihood, administered through a method that raised abject fear in me.
And on top of that, I didn’t feel prepared; the materials I had been given seemed sort of dehumanizing, treating injecting insulin with all the care and consideration of tenderizing a steak. I intellectually understood the clinical depiction and need for clarity in insulin delivery; emotionally, I was still a big fraidy-cat, unwilling to cross that threshold of needles by myself.
The cavalry arrives
I clearly needed help. Thank God for my dear friend Shelley. Shelley is unapologetically 6 feet tall, and she augments her stunning height further with heels; she is confident as she navigates this world, and has the rare talent of accepting vulnerabilities in the people she loves while rejecting excuses she knows are bunk. She walked through my door that night and found me frozen in fear and indecision about insulin.
And she took a deep breath and said: “Hey. Let’s do this.”
So began a multi-hour adventure of psyching me up and getting me comfortable. We watched just about every insulin tutorial on YouTube; some are pretty good. Some are pretty funny. Some are pretty terrible. I do not recommend this training avenue, but we went down it and were OK. We did research on each of the drugs I’d been sent home with, and what to expect in terms of how they’d make me feel and what additional side effects I might experience. We practiced screwing the needle tips onto the pens, and discovered, via vigorous internet search, that needles existed that were a full 2 mm shorter (and thus less painful) than the ones my doctor had prescribed.
We let ourselves be curious, and then, two hours in, came the time for bravery. We cranked the stereo up to 11. We put on Survivor’s Eye of the Tiger (remember this scene from Rocky?) at ear-splitting levels. We found a decently fatty and fleshy part of my belly. And we got ready for me to take the plunge.
And I did it. I stuck myself with the pen and depressed the plunger, taking 12 units of mealtime insulin. And I screamed, as if a water buffalo had uttered a cry of mourning.
I was so dramatic; it really didn’t hurt. Shelley stuck around for the next two injections, which were far less eventful. And from there, I was on my way; insulin was, and is, a part of my life.
For anyone who’s transitioning to insulin, it’s important to remember that diabetes is progressive; this treatment method drastically improves our lives, and there’s no need for the fear of it or shame I experienced. Good control is good control, and insulin helps bring that to the table in ways little else can. I wish anyone considering insulin as a treatment method the good fortune of an excellent educator with a keen eye toward training in this area, and plenty of compassion.
Because let’s face it: needles are not fun. You get used to them, but allowing for the fact that this is a painful necessity goes a long way.
Jonathan Elliott has written for The Guardian, Cinema Blend, and Americans for the Arts. He’s passionate about patient advocacy, diverse abilities visibility, comic books, theater, good books, and bad television, although not necessarily in that order. He works in communications for a statewide not-for-profit organization in his deeply loved home state of New Jersey. He can be found on Twitter at JonathanElliott and Instagram at JonLElliott.