February 4, 2013

Insulin Is Not Punishment

Insulin isn’t punishment like your doctor would like you to believe. Yes, I've said it. There seems to be more than a few doctors that use insulin as a threat to chastise and intimidate people with type 2 diabetes. This is a tool they use to try to get patients on oral medication to adhere to their regimen and not need to go on insulin.

This is the reason I like our group where now 10 of 14 members are on insulin. All of us have type 2 diabetes and we don't feel like we have failed. We just like the lack of side effects and the ease of diabetes management. When I brought this article to the attention of the group, only one member expressed that his doctor had tried this on him and that was the last time he had seen that doctor. Most of the members have chosen to be on insulin after talking with the rest of us, seeing our A1c's, and how we feel on a daily basis.

This article is an interesting one on Insulin Nation. The type 2 person was picked out of a group of people that had taken the A1c test at a Taking Control of Your Diabetes (TCOYD) Conference in San Diego. Her A1c was 11.6%. This was her ticket to a 20-week “Extreme Diabetes Makeover” program led by TCOYD's founder Dr. Steve Edelman. Other members of the team included an exercise physiologist, a CDE, a nutritionist, and Dr. William Polonsky.

We put her on Byetta right after the conference,” Edelman says, “Because she was fighting weight problems and her glucose levels after eating were in the upper 200s, I increased her metformin dose to 1,500 mg at bedtime. Sometimes just shifting the dose to nighttime helps the morning blood sugar.” Stanton's glipizide dose was increased to the maximum, but even the new medications and dose increases were not helping her daily morning readings. This is when they added a long acting insulin at bedtime.

Stanton wasn’t afraid of the shots — both Byetta and insulin required daily injections — but she viewed her need for insulin as a personal failure. For years, her previous doctors had portrayed “going on insulin” as a last resort — the punishment for being a “bad diabetic.”” Where have I heard this before? Yes, this is what I said above was a tool the doctors like to use.

Dr. Polonsky, founder of the Behavioral Diabetes Institute, knew he had to change that feeling and explained that if you have diabetes long enough, you may well need insulin at some point. He also explained that insulin is not only for type 1 diabetes. With type 2 diabetes, the pancreas will eventually quit working when it can't produce enough insulin to help manage elevated blood glucose levels.

Increased exercise and modified diet are not the answer when a person with type 2 diabetes has consistently elevated blood glucose levels. Insulin is the medication that works to bring elevated blood glucose levels down and this is what makes exercise and diet changes work. This should indicate that people with type 2 diabetes need to consider insulin sooner rather than as a medication of last resort.

If you have a doctor that uses insulin as a threat, you have your health to think about and it might be wise to ask the doctor for insulin. If he goes back to using it as a threat or says you are admitting failure, then it is the time to find another doctor. Your diabetes health is not something you should think of as a failure and the sooner you consider insulin, the easier it will be to remain healthy.

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