Insulin for Type 2?

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by Tara Dairman

Should people who are overweight and have Type 2 diabetes take insulin? This question has caused a heated debate between two DSM bloggers and a flurry of reader comments in the last week.

First, nurse David Spero wrote a blog entry about the views of Roger Unger, MD, who says that “giving insulin is one of the worst things you can do for overweight people with Type 2.” He went on to explain Dr. Unger’s theory that taking insulin can increase fat stores in certain cells, leading to more insulin resistance, and that “injecting insulin might go against what the body is trying to do for itself.” David wasn’t totally convinced, but he agreed with some aspects of the theory and asked people with Type 2 diabetes who had taken insulin to share their experiences.

David’s blog entry: Not So Fast With the Insulin?

Then, Jan Chait, who has Type 2 diabetes, responded with a blog entry of her own. She said that Dr. Unger’s views left her “seething,” and that he had his feet firmly planted in the “Blame the Patient School of Medicine.” Quoting an expert of her own (Charles H. Raine III, MD), Jan gave evidence that insulin therapy not only helps many people with Type 2 diabetes control their blood sugar, but may actually reduce their insulin resistance.

Jan’s blog entry: Careful, Your Prejudice is Showing

Overall, commenters seem to agree with Jan more than David. Several of them write about how insulin has helped them control their blood glucose in contrast with the failure of oral drugs, and a few share stories of losing significant weight while taking insulin.

One particularly enlightening comment was submitted by dabernethy, who has Type 1 diabetes and is a medical resident. It gives an in-depth explanation of Dr. Unger’s “lipocentric theory” and concludes that David and Jan are both a little bit right and wrong in their assessments. Read the comment here.

The debate continues, so jump in with your comments on either blog entry! We have also posted a survey where you can quickly note whether you think insulin is a good or bad treatment choice for overweight people with Type 2 diabetes. Take the survey here.

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