At a glance
Insulin therapy is a treatment in which insulin, a hormone that helps cells absorb sugar from the blood, is given by injection or pump to replace or supplement what the body cannot produce on its own.
Normally the pancreas releases insulin whenever blood sugar rises after eating. In people with diabetes, either the pancreas makes no insulin, makes too little, or the body ignores the insulin it does make. Giving insulin from outside closes that gap, keeping blood sugar within a safe range and preventing damage to the heart, kidneys, eyes, and nerves.
Medical Condition
Insulin therapy is prescribed whenever blood sugar cannot be controlled safely by diet, exercise, or oral medications alone. The main situations where a doctor will recommend it are listed below.
- Type 1 diabetes, where the immune system has destroyed the insulin-producing cells of the pancreas entirely.
- Type 2 diabetes that is no longer responding well enough to tablets or other injected non-insulin medications.
- Gestational diabetes (high blood sugar first appearing during pregnancy) that does not respond to diet changes alone.
- Any form of diabetes during surgery, serious illness, or hospitalization, when blood sugar becomes very difficult to control.
- Diabetes caused by pancreatic disease, removal of the pancreas, or certain hormonal disorders.
- Severely elevated blood sugar (hyperglycemia) or a diabetic emergency such as diabetic ketoacidosis (DKA, a dangerous build-up of acids in the blood).
Insulin therapy is not suitable for everyone, and a doctor will review each patient's full medical history before recommending it. Situations where standard insulin regimens may need to be adjusted or avoided include:
- Patients who have very frequent or undetectable low blood sugar episodes (hypoglycemia unawareness), who may need a different insulin type or delivery method.
- People with certain rare insulin allergies or skin reactions at injection sites.
- Patients whose blood sugar is well managed by other means and who do not yet need insulin.
Risks & Complications
Insulin therapy is generally well tolerated, but like any medical treatment it carries recognised risks that patients and their care team monitor carefully.
- Hypoglycemia (low blood sugar): the most common risk, causing shakiness, sweating, confusion, or in severe cases loss of consciousness if blood sugar drops too low.
- Weight gain: insulin encourages the body to store energy, and some patients gain weight over time.
- Lipohypertrophy (fatty lumps under the skin) at injection sites, usually from injecting repeatedly in the same spot.
- Skin reactions at the injection site, including redness, itching, or bruising.
- Rare allergic reaction to insulin, which may cause a rash or, very rarely, a more serious response.
- Hypoglycemia unawareness: after years of low blood sugar episodes, some patients stop feeling the warning signs.
- Insulin edema (mild swelling, especially in the legs) when insulin is started or doses are increased significantly.
- Infection at the needle or cannula (thin plastic tube) site if equipment is not kept clean, particularly in patients using an insulin pump.
Preparation & Procedure
Starting or adjusting insulin therapy involves steps both before the treatment begins and during initial use. Your endocrinologist (hormone specialist) will guide you through each stage.
Before insulin is prescribed, certain tests and checks are usually done. Most patients do not need to fast for these baseline assessments unless a fasting blood sugar test is specifically requested. Any existing medications, including blood thinners or tablets for diabetes, are reviewed to check for interactions or the need to adjust doses. Smoking and alcohol can affect blood sugar significantly, so the care team will ask about these habits and may give specific guidance.
Tests typically run before or shortly after insulin is started include:
- HbA1c (glycated hemoglobin, a three-month average of blood sugar control).
- Fasting and post-meal blood sugar measurements.
- Kidney function tests, because the kidneys are affected by long-term high blood sugar.
- Liver function tests.
- Lipid panel (cholesterol and fats in the blood).
- Thyroid function test, especially in Type 1 diabetes.
- Eye and foot examination to check for early diabetes-related damage.
Once the tests are reviewed and an insulin type and regimen are chosen, the process of starting therapy usually goes like this:
- 1. The doctor explains the type of insulin selected, for example a long-acting insulin given once daily or a short-acting insulin taken before meals.
- 2. A nurse or diabetes educator demonstrates how to draw up or dial the correct amount using an insulin pen or syringe.
- 3. The patient or caregiver practises injecting into safe sites, usually the abdomen, outer thigh, or upper arm, and learns how to rotate these sites.
- 4. A blood glucose monitor (a small device for pricking the finger to read blood sugar) is provided, and the patient is shown how and when to use it.
- 5. The starting dose is set conservatively and then adjusted at follow-up appointments based on the blood sugar readings the patient records at home.
- 6. For patients starting an insulin pump, the device is fitted and programmed by a specialist, and additional training is given on alarms, cannula changes, and troubleshooting.
Aftercare
Insulin therapy is an ongoing treatment rather than a single procedure, so aftercare focuses on building safe daily habits, regular monitoring, and periodic medical review to keep blood sugar under control without causing low sugar episodes.
- Blood sugar monitoring: patients check their blood sugar at home at times set by their doctor, such as before meals, two hours after eating, and at bedtime, and keep a log to share at each appointment.
- Injection site care: sites are rotated at every injection to prevent lipohypertrophy (lumps under the skin), and the skin is kept clean and dry.
- Pump care (if applicable): cannulas are changed every two to three days, and tubing and reservoirs are replaced according to the manufacturer's schedule.
- Recognising and treating low blood sugar: patients and their families are taught to carry fast-acting sugar (such as glucose tablets or a sugary drink) at all times and to know when to seek emergency help.
- Follow-up appointments: an endocrinologist usually reviews the regimen every one to three months initially, then less often once blood sugar is stable.
- HbA1c testing: this blood test is repeated every three to six months to show how well the regimen is working over time.
- Annual screenings: yearly eye, kidney, foot, and cardiovascular checks are standard for anyone on long-term insulin therapy.
- Diet and activity: a dietitian usually provides a meal plan, and physical activity guidelines are adjusted to account for the effect of exercise on blood sugar.
- Sick-day rules: the care team provides written guidance on how to manage insulin during illness, when appetite and blood sugar can change unpredictably.
- Safe disposal: used needles and lancets (finger-prick blades) go into a puncture-proof container, not the household bin.
Cost & What Determines It
The cost of insulin therapy varies widely because it is an ongoing treatment, not a one-time procedure. Expenses accumulate from the insulin itself, the monitoring supplies, and the medical appointments needed to keep the regimen safe and effective.
- Type and brand of insulin: human insulin formulations are generally less expensive than newer analogue insulins (engineered versions designed to act faster or longer).
- Delivery method: insulin pens and their needles, syringes, or an insulin pump with its consumables (cannulas, tubing, reservoirs) have very different cost profiles.
- Continuous glucose monitoring (CGM): some patients use a small sensor worn on the skin instead of, or alongside, finger-prick testing; these sensors are replaced regularly and add to ongoing costs.
- Dose and frequency: a patient who needs multiple injections daily will use more insulin and more supplies than one who takes a single daily dose.
- Hospital class and country: the same insulin analogue can differ in price between a public hospital, a private hospital, and different countries.
- Specialist consultations: regular endocrinology appointments, diabetes nurse educators, and dietitian sessions each carry a fee.
- Routine laboratory tests: HbA1c, kidney panels, and lipid tests are repeated several times a year.
- Annual complication screenings: eye examinations, foot assessments, and cardiovascular checks add to the yearly total.
- Emergency or inpatient care: hospitalisation for hypoglycemia or poor blood sugar control is billed separately and can be the largest single cost.
Hospital packages for insulin initiation, when offered, typically cover the first consultation, initial blood tests, the starting supply of insulin, injection training, and a blood glucose monitor. Ongoing insulin refills, replacement pen needles or pump supplies, follow-up laboratory tests, and specialist review appointments are usually billed separately.
BPJS Kesehatan does cover insulin therapy and diabetes monitoring for eligible members when treatment is received through the BPJS referral network inside Indonesia. However, BPJS and most Indonesian private health insurance policies do not cover treatment received abroad. Patients who choose to manage their diabetes overseas, whether for an initial assessment or ongoing care, typically pay out of pocket or through a private international health insurance plan that explicitly includes outpatient chronic disease management. Requesting a written cost estimate from the hospital before travelling is the most reliable way to avoid unexpected bills.
Frequently Asked Questions
How many insulin injections will I need per day?
The number of daily injections depends on your blood sugar pattern and the type of insulin your doctor prescribes. Some people manage well with one or two injections a day, while others need four or more to keep their levels stable. Your endocrinologist will adjust the schedule based on regular blood sugar readings.
How does an insulin injection feel?
Most people describe the injection as a small pinch that passes quickly. Insulin is given with a very fine, short needle into the fatty tissue just under the skin, usually on the abdomen, thigh, or upper arm. Any stinging tends to fade within a few seconds.
How soon will my blood sugar improve after starting insulin therapy?
Many people notice their blood sugar levels dropping within the first few days of starting insulin. Reaching a stable, well-controlled range usually takes a few weeks as the dose is fine-tuned to your body's response. Progress is checked through regular blood sugar monitoring and, over a longer period, a blood test called HbA1c, which shows your average blood sugar over roughly three months.
How much does insulin therapy cost?
The cost varies depending on the type of insulin prescribed, how many doses you need each day, the class of hospital or clinic, and how often follow-up visits are required. Longer-acting insulin and more frequent monitoring can affect the total expense. Requesting a written treatment estimate from the hospital is the most reliable way to understand what you will be paying.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
