July 10, 2013

Why Is Insulin Considered the Medication of Last Resort?

These are the topics for this blog. Why is insulin considered the medication of last resort? What are the side effects of insulin?

Based on the recommendations of both the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) it would appear that doctors that follow the oral medications route are doing everything correctly. However, after reading the studies, one in Canada and the USA study in Pennsylvania, I feel that the doctors fear insulin and believe in the insulin myths more than their patients. As to the patients fearing needles, yes, there are always a few that have that fear, but most just don't like needles and yet will do what is necessary to maintain their good health.

Whether this is a cover for their lack of being current with the knowledge they need about insulin or their fear of doing something wrong, there is something driving doctors to avoid prescribing insulin. This may be why some doctors use the fear of insulin to keep people on oral medications. It also may be the fear of hypoglycemia that affects their thinking. Of all the excuses, I think the doctors make, probably the more believable is this one by the Canadian doctors when the researchers discovered that many doctors were only familiar with the insulins of past usage and older delivery systems.

Yes, I have enough material to go on an extended rant about the activities of some doctors, but that will not solve the problems of their lack of staying current with the medications, research, and adverse side effects of oral medications. With the current system of shorter time per patient and declining revenues being forced on them by the Centers for Medicare and Medicaid Services (CMS) it is surprising that more serious diagnostic errors are not happening more frequently.

Most doctors will not even have sufficient time to analyze the diabetes algorithm provided by the AACE. This is how bad things are becoming for doctors. And the ADA guidelines probably don't even receive a glance.

The people that need to be hung out to dry are those of the AACE and ADA. They are the ones driving the oral medications market and the AACE algorithm is just another indication of how in bed with Big Pharma the AACE likes to be.

Two other articles create even more concern. Both are in Science Daily and the first one is about the majority of family doctors receiving little or no information about harmful effects of medicines when visited by drug company representatives. What is more disturbing is the same doctors indicated that they were likely to start prescribing these drugs. This is consistent with previous research that shows prescribing behavior is influenced by pharmaceutical promotion.

The second is about a new report that suggests that improved health care and significant reductions in drug costs might be attained by breaking up the age-old relationship between physicians and drug company representatives who promote the newest, more costly, and often unnecessary prescription drugs.

These two articles do point out a larger problem. If the doctors are constantly complaining about not having sufficient time for patients and the CMS cutting reimbursements, then how do they have time to see drug company representatives. Things just don't add up and someone is not counting their time correctly.

Next is a short discussion of the side effects of insulin. The most dangerous of course is hypoglycemia. This is highlighted by my blog of June 20. Apparently the ADA and the Endocrine Society are concerned enough to have issued new guidelines about hypoglycemia. This is an above average report and most people with diabetes need to read this.

Weight gain is common when people with type 2 diabetes start on insulin because they have been forced to wait too long. Their blood glucose levels are higher than they should be and insulin increases the efficiency of glucose absorption by the cells and the excess is stored as fat. If people would just reduce their carbohydrate intake until their blood glucose levels are lower, less weight gain would happen.

Another side effect that many people forget about is during renal problems and fluid retention can be a problem. I also have concern for the small numbers of people that are allergic to insulin. Some are allergic to the analogs and some people are allergic to the older insulins which can still be obtained outside the USA and are legal to import by those needing them. An even smaller percentage is allergic to both types of insulin. Some people will know that they may have an allergic reaction because of the rash that can appear in the surrounding area or this rash can develop over the entire body. The body rash should get immediate attention by a phone call to the doctor.

Many people are not aware of hypertrophy. This is the enlargement of the areas that has received too many insulin injections. This enlargement is often the result of scar tissue which causes insulin to pool in this area and this can increase the enlargement and the scar tissue can trap the insulin and prevent it from getting into the blood stream.

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