Prescribe Insulin? Nah! Too Much Trouble

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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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