Darned If I Can Think of One Reason…

As I was flipping through a magazine the other day, I saw a blurb saying that people with Type 2 diabetes avoid insulin therapy because they don’t want to give themselves injections. But hadn’t I read something recently that suggested just the opposite? Yep, I went back and found this quote from the June 14, 2006, edition of the Indianapolis Star:


“Worried that exploding demand for their diabetes drug Byetta may outrun supplies, Eli Lilly and Co. and its partner [Amylin Pharmaceuticals] are asking doctors to avoid prescribing the popular drug to new patients…Doctors are being asked, starting this week, to hold off in writing Byetta prescriptions for new patients until the new supplies arrive.”

So a medicine for people with Type 2 diabetes, which is injected, was in so much demand that doctors were asked to stop prescribing it until supply (actually, supply of the cartridges Byetta comes in) was increased.

Why would people with Type 2 diabetes run from insulin injections but apparently embrace Byetta? Isn’t it just the idea of giving themselves injections that causes people with Type 2 to shun insulin?

Perhaps not. In research published in the July 2004 issue of the journal Clinical Diabetes, William H. Polonsky, Ph.D., C.D.E., and Richard A. Jackson, M.D., name six different factors that could discourage people from starting insulin therapy, and they opine that perhaps the major contributor to what is called “psychological insulin resistance” could very well be…physicians.

“For example,” they write, “it is common for…patients to be threatened with insulin, to be told that if they don’t work harder to manage diabetes, then there will be no choice but to start insulin, to ‘get the needle.'”

Noting that many doctors fear the extra time needed to start and manage insulin therapy, don’t want to confront patients who don’t want to take insulin, and are concerned about adverse effects, the authors say the physicians may collude with their patients to delay insulin therapy.

“The lessons absorbed,” Polonsky and Jackson write, “are (1) insulin is a bad thing and should be avoided at all costs; (2) if insulin therapy is necessary, it is because you have failed to take adequate care of yourself; and (3) insulin therapy is how you will be punished for your lack of personal success.”

One August day in 1995, I was in a cubicle in the emergency room when a nurse came in with a syringe. When I asked what it was, she said “insulin.” I held out my hand to take the syringe from her. “Tell me what to do,” I said.

I wasn’t afraid to give myself an injection because I’d read a book written by June Biermann and Barbara Toohey that basically said, in a positive way, that injecting insulin wasn’t a big deal. They noted that the needle was thinner than a human hair.

The next week, I asked my doctor to put me on insulin. Shortly afterwards, I ran into the clinic’s medical director as I was picking up a vial of insulin. When he saw what I was getting, his face immediately took on a pitying look and he asked, “Oh! Did she put you on insulin?”

He was a bit taken aback when I responded: “Yes, and it’s great! I feel so much better!”

(By the way, the clinic was associated with a family practice doctor residency program. I wondered, was this doctor conveying that attitude to the residents, who would then convey it to their patients?)

The reality is that Type 2 diabetes is progressive. Over time, it may take more powerful therapies to maintain good blood glucose control. Estimates are that between one-third and one-half of people with Type 2 diabetes will eventually need to take insulin.

It’s quite possible that Byetta is only a stop on the way to insulin therapy for many people. Perhaps people will at least lose their fear of the needle, but fear of insulin may remain unless the possibility of needing it is presented in a more positive manner.

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  • Douglas T. Hawes

    I am a 71 year old who was diagnosed as prediabetic 2 years ago. My father was diagnosed as type 1 at 20 years of age. He lived to 71. From what I learned living with him and from what I have read in the last 2 years I assume that insulin therapy will reduce blood sugar levels and that is very desirable. As my blood sugar seems to be slowly rising inspite of dieting and exercise I’m assumming that I will be going this route shortly.

    I am curious to know more about the alternatives. But, expect to do something other than diet and exercise soon.

  • I am a school bus driver. If I start on insulin I will lose my school bus certificate and will be without a job. I am raising two teenagers on my own, so for now, I must control my diabetes with pills. I feel tired all the time.

  • prd3806

    For me it was not fear of the needle but rather fear of gaining weight. I was already 70 pounds overweight and I was not looking forward to gaining more.

  • Betty

    I am not an insulin user as yet but I remember what my Mother had to say about it when she made the change from oral meds to insulin. It was not giving herself a needle that became the issue. (I learned at the time how to do it as a back up) She explained it like this. It took a longer period of time to deal with the testing and preparation to give herself the needle than it did to pop a pill while eating a meal. She worried and had problems while on insulin about going into low blood sugar with insulin (stress about eating on time) It became more invasive on her life style. Because she was older when she went on insulin she was likely more stressed out.

    Oral meds are just easier to deal with. There is no doubt that insulin use does change your life to some degree. It is an adjustment that must be made when that time arrives. Just as adjusting to medication must be made.

  • Liz

    I disagree with your comments about starting insulin. I started a year ago, because my doctor insisted I had to. I do not feel better, and I do not sleep better. When I complain about how painful the injections are, I am told “they are not painful, you just don’t want to do it”. Yes, my blood sugar is down, but all the promises of how great I will feel are greatly overrated.

  • Deputy53

    I note with interest the comment posted by Basketcaz. It’s not funny that being on insulin can affect your job status, BUT! it can! In Florida I can be a Certified LEO-(Law Enforcement Officer), yet by being insulin dependent I can NO LONGER be part of “high risk” groups. I had to give up my SWAT standing with the department, along with the extra pay. It’s bad enough to have to be a diabetic, but to be “job penalized” for the condition is a little to much. I can understand IF I had one occurance of an “attack” of any kind. I think the powers to be in Tallahassee need to worry about the “Rambo’s” and mentally unbalanced people carrying weapons, then people with under control medical conditions trying to pay their bills. In closing, I have been a type 2 since 1988 and was approaching maximium oral medicine intake. Under my doctor’s advice I went on Lantus in March 06. It has made all the difference in my life, except my paycheck. But once the state found out-there’s no going back!

  • mrtweet

    I was diagnosed as Type 1 when I was 30. After adjusting doses with my doctor, I was taking an am shot and a pm shot. Then around 45, I started taking the before lunch shot. Now I’m 61, retired, and afraid to go out, I take 4 shots now, test a lot, have lows now and then, but being on insulin doesn’t allow me to enjoy retired life cause I’m afraid to go anywhere and if I do,,there’s all that stuff you have to carry with you, not fun.

  • sherryssister

    Thank you for your insight and optimism. I was married to an insulin-dependent diabetic for 15 years. He was always out of control, and he had reactions constantly because he would not (or could not) monitor his BG. My 30 year-old son is now a type 2 and is talking about going on insulin soon. I panicked, remembering the horrors of insulin reactions, and blood sugars in the 500+ levels as well. But he feels it will help him bring his BG into a healthy range and I am trying to accept that it’s not going to be another horror story.

    On another side, I am now Type 2 as well, but not on meds yet. I’ve rebeled against taking them and he cannot understand why I don’t want medication. Perhaps I should rethink my own aversion, and consider an oral medication before the diabetes begins to affect other areas of my health.

    Thank you all for this site, for your insights and research.

  • Carol

    How refreshing to finally read something positive about insulin. For years, I have encouraged patients to consider its safety and benefits for better BG control. I try to give a brief intro to insulin in my diabetes teaching sessions, hoping that if that patient eventually needs it, he/she might be a little more informed and, therefore, more likely to try it. I do this in a non-threatening way. I use the example of use in pregnancy and its safety record there, and its ability to reduce the risk of complications via better BG control. I also say when I do have a patient who is starting on insulin, “If the injection hurts, I’ll buy you lunch.” I have yet to have anyone take me up on my offer. I agree, too, that physician reluctance that may come from a lack of knowledge about insulin, particularly the newer analogs, is at least part of the problem. Thank you so much for publishing this piece! A Nurse Educator from Ohio

  • Margret

    I want to add my two cents worth regarding insulin. I am 35, was diagnosed at 33, and have been on insulin for just over two months now. Since starting insulin (one shot with breakfast and one with supper – the 75/25 mix), I feel like I am in control of my body again and it is GREAT! It had gotten to the point where it didn’t seem to matter what I tried – eating less, exercising more, increasing pill dosages/types – my BG readings were too high. I put off insulin for six months, but finally reached the point where I realized that my body wasn’t going to work right, no matter how hard I tried. I was always sleepy, my head hurt, I had no energy, I kept losing weight (the only benefit), horrible mood swings, etc. I’ve gained back 25 of the 50 pounds that I lost (drat), but I feel alive again. I now know that starting insulin is not admitting failure or defeat, and I realize that although I need to be more careful, I can still go camping, jog, hike, go for bike rides, etc.

  • Burbot

    My biggest concern is weight gain and fluid retention. I’ve seen this problem over and over again. In my case, insulin would be a last resort.

  • jdavis

    I was horrified when I saw the picture that accompanied the Sept/Oct 06 article “Insulin Therapy and Type 2 Diabetes- Why it is often necessary”. The picture depicts a frightened pt being approached by someone holding a 1 inch intramuscular needle attached to 10 cc syringe holding about 5 cc’s of some strange blue liquid! This is a gross misrepresentation of what an insulin injection actually is; usually at most a 1/2 inch 31 gauge needle attached to at the most a 1cc syringe; I threw your magazine right in the trash; why would I want my patients to read such misinformation. I am usually a great fan of your magazine, but this was irresponsible publishing.

  • Kristy

    Thanks for saying what you did! My dad who is diabetic and handles his diabetes with pills and diet only always makes it look like those who get put on insulin are flip ups or idiots who don’t know how to manage their diabetes. I was diagnosed as such a few years ago and live in fear that I won’t be * as good* as he apparently is! After all he lost all his extra weight in only 2 months as he so proudly tells me and wonders why I am such a flip up and constantly reaffirms this as he gloats and says in disgust why don’t lose my weight?? I have tried and tried and tried and no success until I went on Byetta. I have lost 10 more pounds! Which isn’t alot and doesn’t show : I have at least 40 more to lose! I get so discouraged. But being positive about this byetta to insulin idea that byetta will help transfer over to insulin and help you lose your fear over injections and that insulin isn’t necessarily a pointer to being a flip up sure helps me feel better………THANK YOU!!!

  • Jessica

    I have been a type 2 diabetic for about three years now. I’m am 21 years old and I have been on and off oral medication. I don’t have health insurance so I don’t know the status of my disease but I’m scared my doctor wanted me to go on insulin the last time I was there but I refused. I don’t take my pills anymore becuase I have seen a tremendous weight gain. My friends mom told me about byetta and it intrigued me I’m happy that I read your post but I am still a little nervous about sticking myself with a needle two times a day for the rest of my life it seems like I would be held back from alot of things and possible a career. It’s horrible we need a health reform