DIABETES WITHOUT

DIET CULTURE

INSULIN
A USER GUIDE
brought to you by:

ERIN PHILLIPS, MPH, RD, CDCES

REGISTERED DIETITIAN & DIABETES EDUCATOR
ERIN PHILLIPS NUTRITION, LLC

www.erinphillipsnutrition.com @erinphillipsnutrition
Disclaimer: This guide provides non individualized diabetes self-management education by a Certified Diabetes Care and Education
Specialist. The information and other content provided in this document, or in any linked materials, are not intended and should not be
construed as individualized medical advice, nor is the information a substitute for professional medical expertise or treatment.
If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical
treatment. Never disregard professional medical advice or delay in seeking it because of something that you have read in
this guide or any linked materials. If you think you may have a medical emergency, call your doctor or emergency services
immediately.

COPYRIGHT 2023
 Who Am I?
I’m Erin Phillips, MPH, RD, CDCES

My mission is to support people

with diabetes and the people who
love them (clinicians and family
members alike) to live a long and
happy life with diabetes without
food restriction, diets or shame.

I am a Registered Dietitian and

Diabetes Care and Education
Specialist and work with people all
over the world through my practice,
Erin Phillips Nutrition, based in
Seattle, Washington.

I have been working with people

with eating disorders, disordered
eating, and chronic dieting since
2015 and with people with diabetes
since 2010.
I’m so glad you’re here, no
I’m also an avid cat lover, wanna be matter where you are on
dog parent, (very amateur) rock
your journey to learning
climber, quilter and knitter. I’m
more about insulin and
going to attempt to knit a sweater
caring for diabetes.
soon, wish me luck!

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

INSULIN OVERVIEW
ABOUT THIS GUIDE
This guide is intended to be
used to provide you
education and information
about insulin with the goal
of guiding you in having
conversations with your
health care team regarding
the use of insulin.
It might help you decide
whether or not insulin is for
you, or it might help you
tailor the types of questions
you'll ask your healthcare
provider.
So much of the diabetes
education information out
there is provided alongside
triggering information, so
my hope is to give an
alternative that is as safe
as possible for you.
I hope it's helpful!
xoxo,
erin
ERIN PHILLIPS NUTRITION COPYRIGHT 2023
INSULIN 101
Insulin is a hormone produced by the
pancreas. It's primary function is to move
glucose from the blood into the cells to be
used as energy (it's a wonder- hormone if you
ask me!).
In type 1 diabetes, the pancreas stops
producing insulin. With Latent Autoimmune
Diabetes in Adults (LADA/Type 1.5), the
pancreas stops producing insulin at a slower
rate than with Type 1.
In type 2 diabetes, the body uses insulin
differently, and over time (anywhere from a
few years to 30+ years), the pancreas
gradually decreases the amount of insulin it
can produce and blood sugar rises. Eventually,
it's common for the body to need extra insulin
via injection in order to help move glucose into
the cell.
SUPER IMPORTANT REMINDER!
Starting or increasing insulin NEVER means
that someone has done something wrong
or has failed to manage their diabetes.
Insulin is used to maintain or improve
quality of life. Many people find a lot of
relief after starting insulin because it works
wonders for lowering blood glucose and
can help with eating flexibly rather than
with rigidity.
 Should I Start Insulin?
REASONS YOU MIGHT WANT TO START INSULIN
Your current meds aren't cutting it
If your blood glucose is suddenly or gradually higher than it has been for
months/years, it could be time to add another medication. (Remember that
diabetes is progressive, so it's totally normal to need to update your management
care plan now and then.) You could try adding other oral medications, or you
could try insulin. If you've already tried a number of oral medications and they
didn't agree with you, or if you are at the maximum dose of oral medications, that's
a great reason to start insulin!

Your blood glucose has jumped much higher than before

Blood glucose will jump up higher than usual for a lot of different reasons
(stress, injury, illness, certain medications like steroids), and insulin is a
great way to help the body decrease blood glucose quickly. It's common to
need insulin for a little while (think: after surgery) and then not need it once
your body has healed.

You want more flexibility with eating

If you have been trying your darndest
eminder!
to get blood glucose to come down R
with food changes or if the thought of
making changes to your eating is
triggering or just a horrible thought Starting insulin is not a
"worst-case scenario!" It's a very
(super common!), then adding insulin effective way of managing blood
can give you a LOT more flexibility with glucose.

eating. Other meds and methods can be

great too - every body will respond
differently to each med.

Let's include insulin in the array

options rather than trying to avoid it.

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

 QUESTIONS TO ASK YOURSELF
If insulin is something you've tried to avoid in the past, ask
yourself the following questions, allow yourself to feel the
feelings that come up, and discuss with your team.

About your thoughts, beliefs, and feelings:

What was making me want to avoid insulin?
Are there ways of managing those fears/worries?
What is the story I'm telling myself about my body needing insulin?
Are the stories and/or the reasons I wanted to avoid insulin rooted in
MY values or someone else's?
What would I say to a friend in the same situation?

About your relationship with food now and in the past:

Is my situation any different now
than it was the last time my A1c
was closer to my goal?
Was my management back then
If everything was the same back
sustainable?
then as it is now, and you were
How was my mental health at satisfied with your management at
that time, it probably means that
that time? your pancreas has decreased the
How were my relationships? Was I amount of insulin it is producing,
or your body needs an extra
able to be fully present in my temporary boost of insulin to get
relationships or was I having to blood sugar back down.
Remember: that's totally normal!
sacrifice them for the sake of my
food restrictions?

If you're still feeling on the fence about it...

What if you treated it as an experiment? Try it for 2-3 weeks and see
how it goes. Then come back together with your team to talk about it all
- pros, cons, worries, etc. You will have more data to help make a
decision regarding your diabetes care.
ERIN PHILLIPS NUTRITION COPYRIGHT 2023
QUESTIONS TO ASK YOUR DOCTOR
Your healthcare team is critical to making a decision about
making a change to your diabetes care plan. Ask your doctor the
following questions to help figure out if a transition to insulin is
right for you.

About insulin and your diabetes care plan:

Which type of insulin would be most effective in helping me manage
my glucose? You can read more about the different types of insulin
to prepare to discuss this question on the following pages.
How many times would I need to take insulin per day?
How much insulin would I need to give myself per injection? How do I
adjust my doses to correct for high blood sugar?
How much does insulin cost per month? How can I save money?
Would we make any changes to any other part of my diabetes care
plan if I start insulin?
Can I do a trial of insulin for a short period to see how it fits into my
life?

If you're dealing with weight bias (credit to Ragen

Chastain for these questions):
What would you advise someone in a thin body? (Not ideal since
each body needs different care, but can be helpful when dealing with
a provider with overt weight bias.)
Do thin people with diabetes use insulin? What do you recommend
for them?
Shame is bad for my health. I would ask that you first do no harm and
provide me with shame-free healthcare.

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

 TYPES OF INSULIN
There are four main types of insulin, and each
acts differently in the body:
rapid-acting
short-acting
intermediate-acting
long-acting

There are three factors that are unique to each

type of insulin:
onset (when it starts working)
peak (when it's working the hardest)
duration (how long it keeps working in the body)

These factors are important for you to know because:

It affects when you'll take the insulin
You're the one giving your doses!
The more you know about the insulin(s) you use, the more confident
you'll feel in using it.

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

What to Know Once You Start
You've started insulin - You got this!
Here are my top 4 tips:
1. It is normal for your blood sugar levels not to respond
right away.
Reason #1: An insulin dose can be anywhere from 1 unit to 400 units or more! That means it's
going to take some time for you and your team to figure out what the right dose is for your
body right now.
Reason #2: With long-acting insulin, it takes a few days or more for it to build up efficacy in
the body.
2. Know the signs/symptoms of hypoglycemia and how to
treat it
Signs/symptoms: glucose levels <70 - Shaky, sweaty, light-headed, confusion
Treatment: follow the "rule of 15" - If glucose is less than 70, take 15 grams of fast- acting
carbs (juice, honey, skittles, glucose tabs, etc), wait 15 minutes and check glucose levels
again. If still less than 70, eat another 15 grams
Remember: when in doubt, treat!

3. Rotate your sites

Injecting insulin into the same place on your body (or the same 2-3 places) over time can
cause a hard lump under the skin called lipohypertrophy, which decreases how well insulin
can be absorbed.
Make sure to rotate the sites you use to avoid this.
Spots you can use to inject:
Belly (2 inches away from belly button)
Outer thighs
Hips/upper buttocks
Back of the upper arms (this spot is difficult unless someone else gives the injection)

4. Take your insulin out of the fridge AFTER you open the
vial/pen to help with pain
Store your unused insulin in the fridge.
Once you open the vial/pen, you can store it anywhere - it should be discarded within 28
days after opening and doesn't need to be stored in the fridge anymore.
Room temperature insulin is much more comfortable to inject than cold insulin!

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

 FAQs
Does giving an insulin injection hurt?
People are often surprised to find that injections really don't hurt at all! In
fact, most find that pricking their finger for a glucose check hurts a lot more than
an insulin injection. It is normal, however, for it to sting a little bit. If you regularly
feel a burning sensation, let your team know.

Now that I'm on insulin, should I stop my other

medications?
Not necessarily! It's very common for people to stay on other medications while
insulin is added.

Metformin is an example of a medication that works in conjunction with insulin

to make the insulin you take work better in your body.
There are other medications that are usually discontinued when starting
insulin.
Ask your team about which medications you should continue and which you
should discontinue, if any.

Do I have to figure out how to give injections myself?

Nope! There are many people that can help teach you to give injections.
Your medical provider or someone in their office can help you, or the
pharmacist where you pick up your insulin prescription. This can be especially helpful if
you are hesitant about needles or injections because you can practice on a training pad
especially for this purpose (or even an orange works great!) before trying on yourself.

ERIN PHILLIPS NUTRITION COPYRIGHT 2023

 more
FAQs
Does insulin cause weight gain?
In short - NO! This is a myth. I believe that it comes from a combination of two
things: First, with older versions of insulin (did you know insulin has been around
since the 1920s?!), people had to eat to match their insulin dose rather than dose
their insulin to match their eating. Second, if someone has lost weight prior to a
diabetes diagnosis, it's most often because their cells are starving (malnutrition!)
and insulin is what is needed to make them nourished again. HOWEVER, I want to
emphasize that gaining weight is not a bad thing, and being afraid of weight gain
can be harmful to our (physical, mental and emotional) health.

Does starting insulin mean I'm going to start having

diabetes-related complications (eye, nerve, kidney
damage)?
Absolutely not! This is myth. Full stop. Insulin does not increase risk of
diabetes-related complications.

Do I have to count carbs if I'm taking insulin?

This really needs to be individualized and is only applicable with rapid-acting
insulin (see the page on types of insulin). If counting carbs is upsetting or
triggering your dieting mind (normal and understandable!), then talk with your
provider. Ask your team if you can do set dosing (taking the same amount for
each meal), or dosing for small/medium/large meals or low/medium/high carb
meals. These options aren't for everyone, but it's definitely something you can
discuss with your provider.

ERIN PHILLIPS NUTRITION COPYRIGHT 2023