November 12, 2013

Insulin Is Not Punishment, But Best for Diabetes Health


Do I believe this, yes, definitely and I advocate for this. Too many doctors use insulin as a threat to keep people with type 2 diabetes on oral diabetes medications. Because of the American Diabetes Association and the American Association of Clinical Endocrinologists, these doctors are taught that oral medications are the first line of treatment. And, these two organizations preach this to all and emphasize this repeatedly.

What I do not understand is where is the clinical evidence to justify this? Sadly, this evidence is lacking and they are doing this at the request of pharmaceutical manufacturers. When the officers of both organizations take payments from pharmaceutical manufacturers, they cannot be trusted in what they declare is best for people with type 2 diabetes.

Given the unsurpassed efficacy in the management of diabetes, insulin is resisted and feared for its risk of side effects. Yes, hypoglycemia is a very real concern, but if people would be more careful in cutting the carbohydrate intake until they have adjusted to insulin, weight gain can be minimized. Many providers (doctors) use insulin as a last resort therapy and patients have gone along with them.

Some doctors force patients to stay on oral medications until there is a poor prognosis, insulin is required, and the insulin is presented as a form of punishment for poor self-management. Doctors doing this should be banned from the practice of medicine.  Education, which these doctors refuse to use, is the main reason for patients resisting insulin.

Of course, the fear of needles exists, but these can be overcome with patient education. With the new thinner and shorter needles, education will often put these fears to rest. Education about the newer insulins of today that are not animal or human based, but analogues can be the appropriate agents to improve glycemic management, better adherence to treatment, and lower healthcare costs.

While I will never use insulin pens, it is known that many patients do prefer them because they are easier to use, more discreet, and deliver a more accurate dose of insulin. With proper education, they are associated with greater adherence and better diabetes management when compared to vial and syringe use.

Insulin therapy should never be the medication of last resort. I find it easier to manage my diabetes with insulin and will never consider oral medications as being safe except for metformin. There are just too many side effects that are adverse with most oral diabetes medications. Even with metformin, the one thing to be careful of is vitamin B12 deficiency. Contrary to the doctors that claim to know nutrition, some people have problems with obtaining B12 from natural or food sources.

1 comment:

Denise @ Do you have that in my size??? said...

I agree with this post. My endocrinologist didn't want to put me on Lantus until we'd exhausted every other oral med plus Victoza. It was only when I was on Victoza, Metformin, and Glipizide and STILL had an A1c over 9 that I forced the issue and asked to be put on Lantus. Now, as it turned out, the maximum does of that formulation did absolutely nothing in terms of lowering my numbers, but at least I tried it. I've made drastic changes to the way I eat and exercise since then and my numbers are quite good with only one does of Metformin per day now, but I know that I'll press for an insulin option if that ever changes.