Refusing Insulin Therapy


It’s a familiar refrain among many people with Type 2 diabetes[1], with varying wording but an idea that remains constant: “I hope I don’t have to go on insulin[2].” There are a number of reasons why people express a desire to avoid insulin, from a fear of needles to a worry it means they’ve “failed” at managing their diabetes. But until lately, it hasn’t been clear whether these misgivings have much of an impact on when people begin insulin therapy.

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A recent study, though, sheds light on just how widespread insulin avoidance is. Published in September 2017 in the journal Diabetic Medicine, the study[3] looked at the notes of 1,501 primary care doctors between 2000 and 2014, looking for records of patients declining insulin therapy using a computer algorithm. They found that out of 3,295 people with Type 2 diabetes whose doctor recommended insulin for the first time, 29.9% initially refused the treatment. Disturbingly, people with an HbA1c[4] level (a measure of long-term blood glucose[5] control) of 9.0% or higher were more likely to refuse insulin — with a refusal rate of 34.2% — than those with an HbA1c level between 7.0% and 8.9%.

Another troubling outcome of the study is that among people who initially refused insulin, only 38.0% ever changed their minds and began taking it. Within this group, the average delay between an initial insulin recommendation and actually starting on the therapy was 790 days, or over two years. As noted in a Reuters article on the research[6], the study’s authors emphasize that this long of a delay — especially given the high blood glucose levels of the people involved — significantly increases the risk of diabetes complications like vision problems[7], kidney disease[8], and cardiovascular events like stroke[9] and heart attack[10].

As the Reuters article notes, while previous studies have found that many people with Type 2 diabetes don’t start using insulin when it’s needed, this study was specifically designed to find out how often such a delay was due to patients refusing a recommendation, rather than doctors failing to recommend insulin early enough. One older study[11], published in 2009 in the journal BMC Endocrine Disorders, found that the average time between first taking an oral diabetes drug and starting on insulin (in the British study population) was 11 years — and that by starting on insulin eight years earlier, people could increase their life expectancy by an average of 0.61 years and reduce or delay diabetes complications.

What’s your experience, if any, with reluctance to start on insulin — have you ever told your doctor you’d rather avoid insulin? If so, what was your doctor’s response, and how long do you think you delayed insulin as a result? If you’ve ever been reluctant to take insulin, why do you think this is the case? If you’ve started taking insulin, how do you feel now about it now, compared with your earlier views and expectations? Leave a comment below!

Want to learn more about insulin? Read “What Does Insulin Do?”[12] “Types of Insulin,”[13] “Everything You Ever Wanted to Know About Injecting Insulin,”[14] “Getting Down to Basals,”[15] and “Selecting an Insulin Program for Type 1 Diabetes.”[16]

Endnotes:
  1. Type 2 diabetes: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/type-2-diabetes/
  2. insulin: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/insulin/
  3. the study: http://onlinelibrary.wiley.com/doi/10.1111/dme.13454/full
  4. HbA1c: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/hba1c/
  5. glucose: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/glucose/
  6. article on the research: https://www.reuters.com/article/us-health-diabetes-insulin-delay/many-adults-with-diabetes-delay-insulin-therapy-idUSKCN1C22VU
  7. vision problems: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/retinopathy/
  8. kidney disease: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/nephropathy/
  9. stroke: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/stroke/
  10. heart attack: https://www.diabetesselfmanagement.com/diabetes-resources/definitions/silent-heart-attack/
  11. older study: https://bmcendocrdisord.biomedcentral.com/articles/10.1186/1472-6823-9-19
  12. “What Does Insulin Do?”: https://www.diabetesselfmanagement.com/blog/what-does-insulin-do/
  13. “Types of Insulin,”: https://www.diabetesselfmanagement.com/blog/types-of-insulin/
  14. “Everything You Ever Wanted to Know About Injecting Insulin,”: https://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/everything-you-ever-wanted-to-know-about-injecting-insulin/
  15. “Getting Down to Basals,”: https://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/getting-down-to-basals/
  16. “Selecting an Insulin Program for Type 1 Diabetes.”: https://www.diabetesselfmanagement.com/managing-diabetes/treatment-approaches/selecting-an-insulin-program-for-type-1-diabetes/

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