September 22, 2015
Move Insulin to the First Line of Treatment
I hope Patrick Totty of Diabetes Health is right. With all the problems being discovered with the oral medications, insulin may soon be the medication of choice. Presently the only safe oral medication seems to be metformin.
Early-use of insulin isn’t a new notion. Over the past decade, numerous studies have supported the early introduction of insulin in some type 2 cases. One example of research into the concept is available at the National Institutes of Health. Googling “early insulin treatment” brings up many similar studies. Read the Diabetes-in-Control report here.
I do like this idea, but, yes one of these, I have to wonder if doctors will accept this and knowing what some doctors say, many do not believe in insulin and only recommend oral medications on top of oral medications. I think that making insulin a first- rather than a last-resort medication should be seriously considered.
In the past, the initial treatment for type 2 diabetes has been a sulfonylurea and metformin. This means the sulfonylurea is used for increased insulin production and metformin is used for a decrease in liver-produced glucose levels. As is the case of sulfonylureas, eventually begin to lose their effectiveness. This then leads to diabetes becoming progressive.
Patrick Totty has talked to Professor John Wilding, a British endocrinologist and diabetes researcher, who said he has been recommending the early use of insulin as a routine element in the treatment of many recently diagnosed type 2s. I have heard this from a few endocrinologists in the USA and as Mr. Totty has heard, the reason for doing this is to overwhelm early type 2 diabetes and its unwanted effects on blood sugar levels. This says that the progress of diabetes may be delayed indefinitely, and occasionally permanently.
The great thing is that insulin provides a “rest period” for pancreatic beta cells that have been heavily stressed as patients move from metabolic syndrome or pre-diabetes to full-onset diabetes.
One of the good things about starting on insulin is that it’s compatible with some other type 2 drugs, such as metformin or gliflozins. Because those drugs are directed at other organs than the pancreas (metformin/liver; gliflozins/kidneys), they can join insulin in as an effective team. By separately acting to reduce blood sugar levels, those two drugs can bring down blood sugars to a point that allows insulin users to inject lower doses than if they were using insulin alone.
Nor only is it needles that cause people with newly diagnosed type 2 diabetes to
resist adding insulin out of the gate to their medicinal routines. The news that you’re diabetic is hard enough by itself to wrap your mind around, never mind committing to a treatment that involves sticking yourself several times per day. Much of people’s dread of needles comes from mental images of being on an endless treadmill of self-administered shots.
Modern needles are very short and incredibly thin, much of the public and many type 2s still perceive insulin as a last resort, a sort of final defense when all of the other available defenses have crumbled. But, for many endocrinologists and healthcare providers delaying insulin is like refusing to use the best weapon in the arsenal in the years-long struggle against diabetes.
The prospect of being able to overwhelm early onset type 2 will persuade many of the newly diagnosed to start with insulin. As patterns and evidence develop in favor of early insulin treatment, other type 2s, formerly reluctant to make the jump to insulin, may rethink the whole matter.
Once this is accomplished, the doctors will need to be convinced and the people with type 2 diabetes will need to learn how to change lifestyle habits and strongly consider low carb/high fat meal plans.