March 2, 2013

Why Oral Medications First?

It is seldom that I think that the people making comments are more knowledgeable than the author of the blog, but this blog site seems to be more this way the longer it stays in existence. I say bravo to the people good enough to make comments to a decidedly lackluster blog.

The question is why insulin is only considered after oral medications are shown not to work any longer. All we need do is look back at the April 2012 American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) hyperglycemia guidelines for an answer. Tom Ross blogged about it here and later I blogged about it. In addition, this has been part of the ADA guidelines for several years. They want oral medications used until insulin becomes necessary for type 2 diabetes..

Then if you add to this, the threat of insulin that doctors use to keep patients on oral medications, it is easy to comprehend why diabetes becomes progressive. Insulin should never be use as a threat and as a medication of last resort. This is the reason I enjoy listening to and reading information put out by Dr. William H. Polonsky of the Behavioral Diabetes Institute of San Diego, California. He correctly says diabetes causes nothing; it is the lack of diabetes management that causes the complications people develop. For those people interested, I would encourage you to use this link and subscribe to at least their newsletter.

I agree with a comment to the blog that recommends reading Dr. Richard K. Bernstein's book, "Diabetes Solution". This will help in understanding the importance of insulin as well as food plans to avoid blood glucose spikes. The author of this blog takes the safe route by using ADA recommendations, which are far from ideal for patients that wish to keep diabetes from becoming progressive. Insulin should be the medication of choice for many patients long before most doctors are ready to prescribe it.

The blog author lists some reasons that doctors are hesitant to prescribe insulin and some are probably true. Most doctors do have a strong fear of hypoglycemia (low blood glucose level) and this causes them to avoid prescribing, as they themselves do not know how to handle hypoglycemia. Many doctors also do not have the time available or access to diabetes educators and do not want the deal with the complexity of insulin therapy.

It is true that some doctors fear insulin more than the patients fear insulin. Even if this is a Canadian study, many US doctors fall in to this category.
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The author is correct in her statement, “Taking insulin doesn't mean that you've failed to manage your blood sugar.” And, remember diabetes is progressive – only if you do nothing to manage it.

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