By Jan Chait | September 5, 2006 5:51 pm
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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