Diabetes Forecast

Insulin: What Your Body Needs

By David Marrero, PhD, Associate Editor , ,

A good friend who has had type 2 diabetes for many years called and said, "My doctor told me I have to go on insulin." As soon as she said it, she began to cry. When I asked why, she said, "It means that I have failed, that I have let down my family." As I tried to assure her this wasn't necessarily true, she blurted out, "It means my diabetes is getting much worse, and I am afraid I am going to suffer and die." When I asked her why she believed this, she said that almost everyone she knew with type 2 diabetes who started insulin developed terrible complications and died soon after they began using it.

This conversation bothered me on several levels. I think it reflects a legacy of health care providers threatening type 2 patients with insulin as a means of improving compliance to diabetes therapy. All too often I have heard of physicians using insulin as a threat: "If you don't take your pills and watch your diet, I will have to put you on the needle!" In this context, it is not surprising that my friend saw the need for insulin as a failure to follow the doctor's orders.

Her comments about insulin and dying also concerned me and, unfortunately, reflect a view that many type 2 patients have about insulin. This is no surprise. For many people with type 2 diabetes, insulin is introduced only after all oral medications have been tried and failed; in essence, it becomes a drug of last resort. In many of these cases, the oral agents have not been effective for some time before insulin is considered. Thus, the patient has already developed many of the secondary complications that plague diabetes, including cardiac-related conditions that are the main cause of death in people with type 2. So, it's likely that my friend saw others placed on insulin after their health was significantly impaired and the chance of death was greater.

I believe that we should view insulin as one of many drugs to treat type 2 diabetes, not as the drug of last resort. Many providers argue that patients are unwilling to use insulin. Increasing research shows, however, that this is less true than many physicians believe. With proper education and discussion of their situation, many people would be willing to try insulin if recommended to do so by their doctor.

The fact is that type 2 diabetes is a progressive disease in which the insulin-producing beta cells may eventually lose their ability to respond to oral medications effectively. Indeed, it is estimated that 30 to 40 percent of people with type 2 diabetes will eventually need insulin. Needing insulin does not mean you have failed. Rather, it means that your body is changing and needs a different therapy.



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