Prescribe Insulin? Nah! Too Much Trouble

Taking insulin is too much of a burden for people with Type 2 diabetes, say 66% of primary care doctors surveyed at one hospital in Pennsylvania.


People with Type 2 diabetes believe taking insulin means they’ve failed to manage their condition, 69% of primary care docs opined.

Glycemic control is better with insulin than with oral drugs (88%) and beginning insulin earlier rather than later can prevent diabetic complications (75%).

But wait! There are all these different insulin products: It’s confusing (53%) to prescribe. The regimen is too complicated (60%) for people with Type 2 to understand.

Insulin is too expensive (16%) for Type 2s.

Insulin is too time-consuming (38%). For Type 2s.

Funny. I don’t hear any of that about prescribing insulin for people with Type 1. But I digress.

The data came from an abstract presented at the annual meeting of the American Association of Clinical Endocrinologists that ended recently in Phoenix, AZ.

Whine, whine, whine. “I know you’re out of control and at high risk for complications, but it’s so difficult for me to figure things out and I just know you won’t like taking insulin, so let’s not bother with it for now.”

Is that good medicine? If you don’t have the time or the knowledge to work with someone on an insulin regimen, shouldn’t you send that person to a specialist? No. Wait. Only 6% of the respondents in the survey believe endocrinologists are the only ones who should manage insulin therapy, but that’s not the only answer.

As I recall, my family practice doc at the time started me on insulin, but didn’t quite know what she was doing. I took myself to an endocrinologist. The endo started me out on dosages, and suggested changes, but my CDE was the one who taught me how to adjust the amount of insulin I took. It wasn’t that difficult.

If you need to take insulin and you’re not given the chance, you’re being set up for diabetic complications. But, before that, you just plain ol’ ain’t gonna feel good. I was drinking water like it was going out of style. Going to the bathroom. A lot. Sleeping so much I was afraid to drive anywhere. Dealing with an ongoing vaginal infection. Feeling as if I had a minor case of the flu all of the time.

It was no wonder. By the time I got to an endocrinologist, my HbA1c was 17.4%. I don’t believe today’s scale goes up that high. No wonder I felt like crap all of the time!

Do you shudder at the thought of giving yourself injections? I used to. But I gave myself my first insulin shot — and didn’t even feel it. The needle is thinner than a human hair, it isn’t that long, insulin dosages aren’t that large, and it’s injected into the fatty layer (no nerves).

After only three or so days on insulin, I felt so much better! It was like having energy in a bottle! I couldn’t wait until it was time to take my next injection. “Betcha thought you were just getting old,” my boss — a Type 2 on insulin — said as he chuckled.

Oh. And I wanted to have sex again. My poor husband was probably ready to run the other way when he saw me coming toward him.

And, no, going on insulin — or even adding a pill or increasing the dosage of a pill — doesn’t mean you can’t manage your diabetes or that your diabetes is getting worse. It’s just the nature of the diabeastie that most people’s pancreatic beta cells (the ones that make insulin) continue to poop out so that, as you age, you’re going to need more, or different, medications.

As an aside here, insulin isn’t a medication. It’s a hormone. It’s a hormone that everybody uses, even if they don’t have diabetes. If you don’t have diabetes, your body releases insulin around the clock just to run your body. In diabetes speak, that’s called a “basal rate” and is taken care of with long-acting insulin. When you eat, the pancreas of somebody without diabetes releases a spurt of insulin to keep blood glucose from rising too high. In insulin land, that’s called a “bolus” and consists of fast- or rapid-acting insulin.

Dr. Allen B. King, an endocrinologist in Salinas, CA, gives newly diagnosed Type 2s people a cocktail of oral medications, then reduces dosages or takes medications away depending on how well the regimen is working. Psychologically, he says, it’s better to take away than to add. Plus it gets people under control faster.

If the oral meds don’t work within a certain amount of time — and it isn’t that long — the person is on insulin.

Speaking of oral medications, if primary care physicians think the different kinds of insulin is confusing, what about oral medications? Sheesh! From one type in the 1950’s to another type added in the mid-1990’s, that category has exploded!

It began with medications that stimulated the pancreas to release more insulin. Then came metformin, which suppresses glucose production by the liver and improves insulin sensitivity. Since then, there are all kinds of oral medications that work on different aspects of Type 2 diabetes. I can’t keep up with them all.

Insulin? Easy. You’ve got long-acting, short-acting, and rapid-acting. It’s a naturally occurring hormone. There aren’t a lot of side effects. The needles are tiny and the injections generally don’t hurt. Finger sticks are worse. You can get your insulin from a syringe or from a pen. As far as I know — but I’m only a consumer — it isn’t rocket science.

As far as education goes, doctors are too busy to do that. But CDEs are an excellent resource. All the doc has to do is refer you to one.

If you feel like crap, you can’t get your blood glucose under control no matter how hard you try, and your doctor is hesitating to put you on insulin, tell him you want to start on it. That’s what I did 18 years ago, and I’m still glad I did.

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  • Bob Fenton

    Thank you for posting this! Many doctors have more fear of insulin than we as patients do. It is like they believe the insulin myths more than we patients will ever believe them.

    Most doctors do not and will not recommend or refer you to a CDE. The doctors do not believe that the CDEs could know more than they do.

    I continue to advocate insulin over oral medications because of the many side effects of the oral meds. Yet to most doctors, and apparently now with the new algorithm by the AACE everyone now believes that for type 2 diabetes, insulin should be the medication of last resort – to which I say BS! And that does not stand for blood sugar.

    Thanks again!

  • jim snell

    Whoa – 30 year plus type 2 shocked!

    I am on insulin – humalog lispro now and very glad I did. Do not pump – yet.

    I found the oral pills (glyburide/starlix et all difficult and problematic and way too much trouble and impossible to lose weight/diet on pills that drive one’s eating schedule. I wish I never used them.

    Yes it takes time and training for insulin but once on to it I am glad. Also one has full flexible adjustable dose and control which the oral pills do not provide and one has to eat to a railway schedule to prevent lows on the pills.

    I prefer the fast acting humalog lispro or its equivlent from other manufacturer’s that has 3 to 4 hour strike and allows one to adjust up and down with each meal.

    I hate the 75/25 high horse power insulin with its 12 hour strike time that for me makes it most difficult and tricky to use intermediate adjusting doses if needed.

    I have used lantus and that worked and was helpful if one needs basil insulin support.

    So in the end, Jan’s report is excellent and really walks thru the issues and even surprises me!

  • Dick Eastman

    I am a Type 2 diabetic who was taking 8 prescription drugs, including insulin injections. I quit all those about six months ago and went onto a vegan diet in its place. I don’t cheat: I am 100% vegan. I no longer take any drugs other than a daily vitamin tablet.

    Since getting rid of the drugs, my A1c dropped from 7.3 to 6.9, the daily blood sugar readings are usually in the 120 to 14o range (the same as it was when I was taking insulin and other drugs). In addition, I feel 100% better. I am no longer tired all the time and I no longer have dizziness. (I think those problems were caused by other drugs I was taking, not the insulin.) My endocrinologist was surprised but then said, “Don’t change anything!”

    This may or may not work for everyone but I think it is worth a try. There are several good books available about “reversing diabetes” by going to a vegan diet. Read one or two, then try it for yourself.

  • Deb

    My doctor put me on a vegan diet because my cholesterol was high. Result? Diabetes and an allergy to soy. As you say, no one diet fits all. I’m lucky that metformin is working for me – as long as I test and watch my portions very carefully. I stopped testing recently and my AM glucose shot up accordingly – it’s taken a month to get it down, but it works.
    My husband resisted insulin until nothing else was working. He didn’t sleep the night before he had the training, but was astonished how easy it was, and now he never misses a dose.
    So if I need to go on insulin at some point, I’m not as concerned as I used to be, and I know that our endocrinologist won’t hesitate to prescribe it if necessary. I’m printing this post for all the good info in case that day comes.

  • Vicki Baker

    Agree with you Jan as a diabetes educator it is rewarding to start people on insulin knowing they will get quick results and start feeling better soon.

  • Kate

    As someone who asked to go on insulin, I agree with Jan. Fortunately my primary care physician sent me to classes with CDEs before he would write the prescription. So I learned how to manage the insulins and how to adjust doses before I started. The CDEs kept in daily contact by email with me for a month when I did start the insulin, to make sure that I was doing it right and that I didn’t go too low [I was thrilled that I could lower my blood glucose so easily and kind of overdid it. A phone call from a CDE to treat that low immediately set me straight].

    I don’t understand why doctors prescribe oral meds that can have terrible side effects and which don’t bring good control to type 2s when insulin can work so well. If the physician can’t teach insulin management they should do what my doctor did – refer to specialized CDEs who know how to train.

  • Airborne Mom

    Diabeties is a progressive disease. When metformin was not enough I did not want to go back to byetta or actos since those drugs have not had good reviews lately. So I asked my dr to put me on insulin since that is where I would eventually end up. I don’t have to fight with my insurance companies and my dr put me on a 24 hour insulin taken at bedtime. It has been working great for me.

  • Lorraine Starsky RN, BSN

    I could not agree more with Jan. As a Public Health Nurse whose focus is diabetes and who works with vulnerable, medically underserved communities, I wish I had a nickel for every time I heard a primary care physician threatening a Type 2 patient with insulin if they don’t do “better manging their diabetes” as though insulin is a punishment. Time and time again, I have seen too many people delay and delay going on insulin until it is too late and so much damage already has been done to their kidneys, feet, eyes, nerves, cardiovascular sytem, not to mention the years of just feeling lousy. Why, because they are scared of insulin. It pains me to say that that many medical professionals have created and feed this monster of fear of insulin. Jan hits the nail on the head when she indicates that some doctors don’t want to take the time to do all the work and teaching involved with putting a patient on insulin. Well, if you don’t want to do the work or lack the expertise, then refer your patient to Certified Diabetes Educators (CDEs). Better yet, have them right in your office to work with your diabetic patients. I went to a seminar on “Using the Patient Centered Medical Home to Mange Your Diabetic Patients” and listened to a family practice doctor say that he wouldn’t refer his patients to a CDE because “I don’t know what they will tell my patients.” Unbelievable, but sadly true.

  • jim snell

    Excellent comments from Lorraine. Thank you for sharing. After 30+ years as a type 2 now on insulin, I agree fully with her and Jan.

  • Steve P

    now I’m more confused than ever. I thought Lantus was night and Toujeo was day time. I am on 1000 MG of Glumetza, and 45 MG of Actos. Additionally I inject 45-50 units of Lantus at night after my evening meal. My DR. says the Lantus at night is supposed to keep my numbers from spiking overnight. I think he said something about my liver releasing sugar at night? My insurance company no longer wants to cover the Glumetza, and Generic Metformin ER upsets my stomach. I was hoping to ask him If I could get off the Actos and Glumetza, and take Toujeo in the morning and Lantus at night. But that makes no sense if they are the same thing as I recently read. So why am I on pills and Lantus instead of Lantus alone?