Pass the Vial My Way!

During last week’s Diabetes Social Media Advocacy (#DSMA) session on twitter, one of the discussion topics centered around Type 2 diabetics and insulin treatment. Should type 2’s start taking insulin earlier? Should it be avoided at all cost? Does the need for insulin mean the person is a failure for not getting their diabetes under control? Like many others in the DOC, I have my own opinions on the subject, and I voiced some of them during the chat.

First, I am a person with type 2 diabetes, and at present, I am not taking insulin as part of my treatment regimen. I have been given insulin injections during two separate hospital stays in the last year or so, though, so I do at least have a faint idea as to what it’s like.

Now, just because I’m not on insulin right now doesn’t mean that I won’t be in the future. I’m not being negative or pessimistic, I’m looking at this realistically. I’ve struggled with oral medications not working, and I know that insulin may be in the cards. And while I’m not actively pursuing insulin use at this time, I’m definitely open to the idea if and when it becomes necessary.

And if I do end up on insulin, it will not be because of some failure on my part. I put everything I have into fighting my diabetes and keeping it under control. Insulin therapy does NOT indicate failure. It will simply mean that my body needs help getting its’ job done. And there is no shame in needing help. The real shame would be in not doing anything at all.

As I said the during the chat, “If taking insulin means I might live a little longer, by all means, pass the vial my way. It’s called doing what’s needed to survive.” And that’s what it all really boils down to; Each and every one of us doing what is necessary for our own survival. What is right for me, may not be right for you. And that’s OK. The important thing is to figure out what will work for you, put a plan in motion, and then stick with it.

And if you learn something along the way, be sure to share it with someone. It just might make surviving a little easier for someone else.

7 Comments

Rachel

08/10/2010 at 10:02 pm

My thoughts…exactly.

Kate

08/10/2010 at 10:12 pm

I was diagnosed with Type1 at the age of 37, so I began my insulin regimen immediately. I wouldn’t have it any other way. It does NOT mean that you have failed (as I thought – – but I also thought for 6 months that I was Type 2), but that you are giving your body something that it no longer uses well.

Scott Strange

08/10/2010 at 10:16 pm

The myth that “needing” insulin is a failure is probably the myth that annoys me most. What is important, like you said, is that you get the best treatment available for your particular condition

Do what you need too. It’s about what is important to yourself. It doesn’t matter what anyone else says, my friend. It is about what can keep you and your wisdom here for all of us to learn from

Bob Fenton

08/10/2010 at 11:05 pm

Mike, you have it right. I am a T2 on insulin and I am happy that I am. I know my pancreas is getting the rest it needs as there are times when I need to reduce my insulin as the pancreas puts out enough and I will go low if I don’t. I have been ill the last three days and have not needed but half my normal lantus and none of my novolog. Granted I have not been able to keep food down, but it is nice to know that my pancreas is working and has not been worn out by oral meds.

tmana

08/11/2010 at 12:30 am

I think there are several issues that inform the insulin argument in the case of Type 2 diabetes mellitus. One is historical: metformin, one of the oldest oral antidiabetic drugs, is “only” about 50 years old, in comparison with insulin, which is closer to 90. During the earlier part of its reign, insulin injections meant large needles that had to be honed and sterilized before each use, and which (according to reports from those who used insulin at that time) were significantly painful. Pain avoidance is a pretty powerful motive.

Another issue is that Type 2 diabetes does not always progress, or progress at a rate that makes insulin a preferred treatment during a patient’s life. (I’m writing this from the perspective of being 6.5 years controlled by diet and exercise alone — though I’m not so sure I’d consider my numbers to be “in control”, despite an A1C of 5.8.) Related to this is the observation that in many (but not nearly all!!!) cases, Type 2 diabetes can be mediated (that is to say, the condition can be made better or worse) by diet and exercise. Our culture believes that if one does not do the utmost to mediate one’s adverse medical conditions by lifestyle changes, one is lazy and therefore undeserving of help (this relates back to the so-called “Puritan work ethic”). A subtopic of the “heal thyself” ethic is related to body weight, and the association of insulin resistance with obesity.

A third issue relates directly to insulin resistance. It is presumed that the more one is exposed to insulin — whether endogenous (produced by one’s own beta cells) or exogenous (injected), the more insulin-resistant one’s body becomes. There is a fear that starting a person with Type 2 diabetes — who is already presumed to be insulin-resistant — on exogenous insulin will cause that person to become so resistant to insulin that over time, even high doses of exogenous insulin will become ineffective. The theory is that by delaying the introduction of exogenous insulin, one is increasing the patient’s life span (by delaying the development of total resistance to ALL insulin) — regardless of that decision’s affect on the patient’s quality of life (including that person’s timeline for developing complications of diabetes).

The fourth major issue informing the introduction of insulin into the Type 2 treatment regimen is patient training. In addition to self blood glucose monitoring (SBGM) — which many persons with Type 2 still do not do (especially if they are elderly or low-income) — patients on insulin must learn how much basal insulin to take, and when; logging; parameters for alerting one’s medical team and/or changing the regimen (for example, splitting one’s Lantus dose into two separate doses taken roughly 12 hours apart); and so on. In today’s times of intensive management, t is also assumed that at some time after the introduction of basal insulin, a diabetes patient will also need to learn to use mealtime insulin — which requires learning carb counting, carbohydrate to insulin ratios, sliding scales, correction factors, and so on. My impression of this is the equivalent of teaching a university-level course to someone who may not have finished high school, or whose mental processes (if elderly) may have deteriorated past the ability to learn complex new tasks.

All of these issues go into medical decisions to postpone the introduction of insulin in treating Type 2 diabetes — and I’m sure I’ve missed at least as many more.

Mike

08/11/2010 at 3:33 pm

Holy cow, Brenda! There’s more text in your comment than there is in my whole post.

Faye

08/21/2010 at 1:27 am

I completely agree with your post and not referring to type 2’s using insulin as “failure,” and my husband explained to me what they are taught in school. He is in pharmacy school, and they were given an “algorithm” (basically a flowchart-looky thing– something like this http://care.diabetesjournals.org/content/29/8/1963/F2.large.jpg) that has the treatment options for t2. First line of treatment is lifestyle change/pills. If that doesn’t work, the patient is moved to insulin. I think it’s more that the first (or previous) treatment failed, not the person. Sadly, other don’t think the same way.

To me, that just means someone’s body doesn’t respond the same way as another’s (and why should it? Everyone is different). My basal rate averages 1.3/hour; does that mean I’ve failed in comparison to someone whose average is 0.8/hour? I sure hope not. I’m just doing what I need to do to stay healthy and alive.

Rachel

08/10/2010 at 10:02 pm

My thoughts…exactly.
Kate

08/10/2010 at 10:12 pm

I was diagnosed with Type1 at the age of 37, so I began my insulin regimen immediately. I wouldn’t have it any other way. It does NOT mean that you have failed (as I thought – – but I also thought for 6 months that I was Type 2), but that you are giving your body something that it no longer uses well.
Scott Strange

08/10/2010 at 10:16 pm

The myth that “needing” insulin is a failure is probably the myth that annoys me most. What is important, like you said, is that you get the best treatment available for your particular condition

Do what you need too. It’s about what is important to yourself. It doesn’t matter what anyone else says, my friend. It is about what can keep you and your wisdom here for all of us to learn from
Bob Fenton

08/10/2010 at 11:05 pm

Mike, you have it right. I am a T2 on insulin and I am happy that I am. I know my pancreas is getting the rest it needs as there are times when I need to reduce my insulin as the pancreas puts out enough and I will go low if I don’t. I have been ill the last three days and have not needed but half my normal lantus and none of my novolog. Granted I have not been able to keep food down, but it is nice to know that my pancreas is working and has not been worn out by oral meds.
tmana

08/11/2010 at 12:30 am

I think there are several issues that inform the insulin argument in the case of Type 2 diabetes mellitus. One is historical: metformin, one of the oldest oral antidiabetic drugs, is “only” about 50 years old, in comparison with insulin, which is closer to 90. During the earlier part of its reign, insulin injections meant large needles that had to be honed and sterilized before each use, and which (according to reports from those who used insulin at that time) were significantly painful. Pain avoidance is a pretty powerful motive.

Another issue is that Type 2 diabetes does not always progress, or progress at a rate that makes insulin a preferred treatment during a patient’s life. (I’m writing this from the perspective of being 6.5 years controlled by diet and exercise alone — though I’m not so sure I’d consider my numbers to be “in control”, despite an A1C of 5.8.) Related to this is the observation that in many (but not nearly all!!!) cases, Type 2 diabetes can be mediated (that is to say, the condition can be made better or worse) by diet and exercise. Our culture believes that if one does not do the utmost to mediate one’s adverse medical conditions by lifestyle changes, one is lazy and therefore undeserving of help (this relates back to the so-called “Puritan work ethic”). A subtopic of the “heal thyself” ethic is related to body weight, and the association of insulin resistance with obesity.

A third issue relates directly to insulin resistance. It is presumed that the more one is exposed to insulin — whether endogenous (produced by one’s own beta cells) or exogenous (injected), the more insulin-resistant one’s body becomes. There is a fear that starting a person with Type 2 diabetes — who is already presumed to be insulin-resistant — on exogenous insulin will cause that person to become so resistant to insulin that over time, even high doses of exogenous insulin will become ineffective. The theory is that by delaying the introduction of exogenous insulin, one is increasing the patient’s life span (by delaying the development of total resistance to ALL insulin) — regardless of that decision’s affect on the patient’s quality of life (including that person’s timeline for developing complications of diabetes).

The fourth major issue informing the introduction of insulin into the Type 2 treatment regimen is patient training. In addition to self blood glucose monitoring (SBGM) — which many persons with Type 2 still do not do (especially if they are elderly or low-income) — patients on insulin must learn how much basal insulin to take, and when; logging; parameters for alerting one’s medical team and/or changing the regimen (for example, splitting one’s Lantus dose into two separate doses taken roughly 12 hours apart); and so on. In today’s times of intensive management, t is also assumed that at some time after the introduction of basal insulin, a diabetes patient will also need to learn to use mealtime insulin — which requires learning carb counting, carbohydrate to insulin ratios, sliding scales, correction factors, and so on. My impression of this is the equivalent of teaching a university-level course to someone who may not have finished high school, or whose mental processes (if elderly) may have deteriorated past the ability to learn complex new tasks.

All of these issues go into medical decisions to postpone the introduction of insulin in treating Type 2 diabetes — and I’m sure I’ve missed at least as many more.
Mike

08/11/2010 at 3:33 pm

Holy cow, Brenda! There’s more text in your comment than there is in my whole post.
Faye

08/21/2010 at 1:27 am

I completely agree with your post and not referring to type 2’s using insulin as “failure,” and my husband explained to me what they are taught in school. He is in pharmacy school, and they were given an “algorithm” (basically a flowchart-looky thing– something like this http://care.diabetesjournals.org/content/29/8/1963/F2.large.jpg) that has the treatment options for t2. First line of treatment is lifestyle change/pills. If that doesn’t work, the patient is moved to insulin. I think it’s more that the first (or previous) treatment failed, not the person. Sadly, other don’t think the same way.

To me, that just means someone’s body doesn’t respond the same way as another’s (and why should it? Everyone is different). My basal rate averages 1.3/hour; does that mean I’ve failed in comparison to someone whose average is 0.8/hour? I sure hope not. I’m just doing what I need to do to stay healthy and alive.