June 14, 2012

Why Doctors Fear Starting Patients on Insulin

This is a Canadian study, but is applicable to the U.S. physicians as well. The opening statement is a little surprising when the myths about insulin are considered.  For many U.S. patients, the myths are out in full force and both doctors and patients seem to believe many of them. But, I digress.

The statement that doctors are more reluctant to start their patients on insulin than the patients are themselves says volumes and must be explored. Dr. Catherine Yu, a researcher at the hospital's Keenan Research Centre and senior author of the paper states, "There are no clear recommendations on the safest and most effective way to start patients on it, and so physicians are often hesitant to do so."

Dr. Yu and colleagues analyzed past studies to find out what barriers existed to starting patients on insulin, and how insulin compared to other blood sugar lowering medications in terms of its effect on blood sugars and weight. They then made recommendations for physicians and other health care providers based on evidence from the past studies.”

Their findings were published in the online edition of the Canadian Medical Association Journal.

What they found is that doctor's fears of common side effects such as weight gain and low blood sugar were amplified compared to their patient's fears, and that doctors were more concerned than their patients about the possibility of injection-related pain and anxiety. They also discovered that many doctors where only familiar with the insulins of past usage and older delivery systems. They needed to be reeducated about the newer insulins and methods of delivery.

Like many of us now using insulin, we find it much easier to use and if we use care and learn to use it properly. Instead of eating to a certain amount of insulin, we need to learn to count our carbohydrates and adjust our fast acting insulin accordingly. This will prevent most of the risk of low blood glucose and by limiting our carbohydrates, we can prevent the weight gain many fear. Exercise if medically able is another way of assisting the prevention of weight gain.

Although Dr. Yu's suggestion of starting patients on a once a day injection of long acting or 24 hour insulin while reducing the oral medications is good, those of us in our group all went from oral medications one day to insulin injections the next day. Granted this worked well for us and we were comfortable with this transition, some doctors are not. This is why we like our endocrinologists and the assistance they were able to give us.

When insulin myths are taken out of the equation, adapting to insulin use for most people can be efficiently accomplished. Education is required for using the best injection sites and matching rapid acting insulin to carbohydrates to be consumed. It is also wise to eat at regular times and is a person is ill and does not feel like eating, then do not inject the rapid acting insulin. More frequent testing is required and this must become a habit so that adjustments may be made for higher or lower blood glucose readings preprandial (before meals).

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