Diabetes Medication

Use Insulin as a FIRST Resort

You can get the best control over your diabetes by taking insulin until you are ready to go on a very low-carb diet. But if you have type 2 diabetes, you may have always thought that taking insulin was something you used when everything else failed to manage your blood glucose level.

insulin

“If you don’t shape up, I’m going to make you inject insulin,” is a threat we may hear from our doctors. How about turning the table on your doctor and ask for it yourself?

If you really want to regain your health, taking insulin is the quickest way to get there. None of the other good diabetes drugs — the non-insulin injectables or metformin — can bring your blood glucose level down to normal nearly as assuredly as insulin can. While a very low-carb diet can work wonders, some people find it difficult to give up the bread and sweets and others are still suspicious of the amount of fat you need to eat for energy.

Two Myths

While everyone who has type 1 diabetes has to take insulin, of course, only one-fourth of people with type 2 diabetes do. This relatively low proportion is due to two misunderstandings:

Insulin has an undeserved reputation as being difficult to get just right. The amount and time that you take it certainly can be tricky to figure out for the older bolus insulins that you need to take before each meal. But for several years now we have been able to use a basal insulin that we take just once a day without having to calculate how much we eat and when we ate it.

Until recently all types of insulin required us to inject it with a needle, and many people fear that the injection would hurt. In fact, unlike the fingerstick tests that we have to take to check our blood glucose level, insulin injections, they rarely or ever hurt. Even if you have needle phobia, we now have a great way to overcome it called the “Buzzy.” Furthermore, a type of insulin that doesn’t have to be injected became available a few months ago.

What to Ask

If your blood glucose level as measured with an A1C test is above 6.0, you can do your body a big favor when you ask your doctor to prescribe insulin. Here are the first questions to ask:

1. Should I take a long-acting insulin — like Lantus or Levemir? Should I take it once a day, or twice a day, like some people tell me to?

2. Instead, should I take a rapid-acting insulin — like Afrezza — that is inhaled, so I don’t have to inject it?

3. Or should I take both, at least at first?

4. What should I do if insulin makes my blood glucose level gets too low?

5. What other side effects might I get?

6. Should I get a continuous glucose monitoring system, or CGMS?

7. What about getting an insulin pump?

Your doctor will probably be pleased to hear your request to take insulin, especially if he or she has been nagging you to take it. The beta cells in your pancreas that have been working so hard ever since you got diabetes will also be happy, appreciating the break that taking insulin will give them.

This article is based on an earlier version of my article published by HealthCentral.

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12 Comments

  • Reply Bob February 4, 2016 at 1:31 pm

    That’s, PRESCRIBED, not proscribed, sorry!

  • Reply Bob February 4, 2016 at 1:28 pm

    Diagnosed as insulin resistant in 1995. Put on a variety of oral drugs with diet changes (lo carb, etc). A1c levels in hi 6 to lo 7. Put on Lantus post op 3 yrs ago and A1c went below 6. Last winter glucose levels started to rise as well as A1c (to 6.5}. All else was apparently the same. Diabetic specialist had no other suggestion other than more Lantis (@25u now).
    Since last winter been battling persistent post nasal drip which progressed over time(despite a course of anti biotics and an allergy test) to. as bad cough and bronchitis, A visit to another doctor who proscribed a steroid and a stronger antibiotic, and a week later all better. The temp uptick in glucose readings due to steroids subsided and much to my shock, readings fell about 30 to 40 points lower (am fast 92 to 120).
    My wife, an RN, theorized that elevated glucose levels since last winter due to chronic uncontrolled low level sinus infection.
    My takeaway from this… Just about everything out of the ordinary negatively impacts blood glucose levels, and lots of luck getting the average doctor to ask the right questions or listen to your answers.

  • Reply Don February 3, 2016 at 6:13 am

    If some one say something is good, then the person forget to give the argument for that!
    It is a typical behaviour for physicians and doctors. This people think they are in the same family like Socrates. People with Diabetes need to know all details about the problem.
    Stanley Kim write: “However, it’s delivery system to the body is not as good to precisely control the blood glucose level as that of the healthy pancreas”
    Control of the glucose by the people depend of two hormones who interact with each other like a “thermostat”. This hormones are Insulin and Glucagon. Bout of them are produced by Pancreas, by the Alfa and the beta cells.
    If insulin is high, then Glucagon go down. The interval is between about 4 to 6 mmol/l (72 mg/dl to 108mg/dl) .
    By Diabetes t.II the interaction between this hormones has problems. They work independent of each other. This is the reason why people with DM t. II can not regulate the optimum dose of Insulin.
    The only way is to make some experience about the intake of the carbohydrates and the amount of Insulin.
    I know some sport people use Insulin to build muscles. It is because Insulin has anabolic characteristic. If the person is pre diabetic and use Insulin like a sport people, there is risk to get hypoglycemia.

  • Reply Don February 2, 2016 at 10:22 am

    The main reason to become Diabetes t. 2 is the genetic disposition. In spite of the persons education and dietary intervention long before diagnosis for diabetes, if the person has genetic disposition for Diabetes, he or she beyond doubt, will become the diagnose DM t. II.
    The medical treatments for DM t.II all the way is prophylactic.
    On the beginning the person eat healthy and make physical exercises. One day all that is not enough and the next prophylaxis is medications with Metformin. Next to that is medications with the Sulfonylurea drugs. This drugs puffed the pancreas beyond his limits.
    This is the reason why the person has better to start using Insulin and not this sulfonylurea drugs.
    After that the person can combine Insulin with Metformin. Metformin has nothing to do with Insulin, it only make better Insulin sensitivity, help cells to better sense the Insulin and reduce the amount of exogenous Insulin need.
    The best treatment not to become follow diseases from Diabetes t. II is the Tertier prophylactic treatment, i.e. to stop the development of this diseases.
    The person must learn about the Polyol Path.
    way. It is a long story. You can read about it in the English Wikipedia. Our body has some tissues where glucose do not need insulin to enter in the cell. This tissues are: the retina, blood weasels, nerves and the kidney. The main component of the Polyol Pathway are the three enzymes: Aldose reductase, Sorbitol dehydrogenase and the Hexocinase.
    The Polyol Pathwey start if the glucose concentration in the blood is over 5.5 mmol/l.
    This is because the Aldose reductase has the affinity 0 if the glucose is 5.5 mmol/l or below.
    If the person has a glucose levels all the time over 5.5 mmol/l, then the first two enzymes convert the glucose to sorbitol and to fructose. This molecules are large and can not exit the cells. The consequences of that can be they destroy the cells organelles and s.o. Read more about that in the literature.

  • Reply Stanley Kim, MD February 1, 2016 at 9:38 pm

    Sheena and I will be so happy to see you!
    I moved to Claremont, the city next to Upland:
    981 W. Foothill Blvd
    Claremont, CA 91711

    Please email me.

  • Reply Stanley Kim, MD February 1, 2016 at 7:06 pm

    David,
    I agreed with you in principle.
    Insulin is the best drug for all diabetics including Type 2, or even for the pre-diabetics .
    However, it’s delivery system to the body is not as good to precisely control the blood glucose level as that of the healthy pancreas. In fact, pre- diabetes patients often experience hypoglycemia because of too much insulin excreted by the pancreas. It is because the pancreas cannot excret the accurate amount of insulin just enough to lower the high blood glucose level without causing hypoglycemia.
    Therefore, next research should be focused on how to deliver the exact amount of insulin, not what type of drugs/insulin to be used.

    • Reply David Mendosa February 1, 2016 at 8:23 pm

      That’s an excellent point, Dr. Kim! Thanks for your contribution.

      By the way, I was just going to write you. Are you still at the hospital in Upland? I will be driving from Colorado to California to visit my sister in Ontario in a few days as soon as the snow storm here leaves the highways safe to drive. My sister was born in your hospital 77 years ago, and I will be staying with her for about a month. I would like to say hello to you when I am there, if we can meet.

  • Reply Barbara B February 1, 2016 at 5:01 pm

    I strongly disagree that insulin should be a first resort for Type 2 diabetics. People at risk of Type 2 diabetes should be given education and dietary intervention long before they become “pre-diabetic”. When I was diagnosed as a pre diabetic, and then a diabetic, I was eating a Mediterranean lifestyle and had cut carbs down. After research, I chose to do a low carb, moderate protein and moderate healthy fats lifestyle. I did not want to take Metformin or insulin. Why-when I could make the changes needed to maintain healthy blood sugars without medical intervention ? Couple that with mild exercise and I have no need of medications and have normal lipids.

    • Reply David Mendosa February 1, 2016 at 5:10 pm

      Yes, Barbara, in an ideal world education and dietary intervention long before someone becomes pre-diabetic or diabetic, would be great. But you and I know that this just doesn’t happen.

  • Reply Don February 1, 2016 at 9:24 am

    To Roger
    In the beginning of the DM t 2 your body produce max endogen insulin. Your insulin resistance must have more insulin to bring the glucose in the lever and the muscle. This is the reason why you shod use exogenous insulin. Moreover with the time amount of your endogen insulin from pancreas will be low. You can check it with the blood test for C-peptide. Then you need more insulin.
    The insulin therapy with exogenous insulin can be combined with metformin to increase your insulin sensitivity.

  • Reply Roger February 1, 2016 at 9:01 am

    If type 2 diabetes is being insulin resistant due to too much insulin in your bloodstream then how does adding “fuel to the fire” help? Seems to me like you want to lower the insulin not increase it.

  • Reply Ralf January 11, 2016 at 10:27 pm

    Hmm. Something doesn’t sound right.

    “If you really want to regain your health, taking insulin is the quickest way to get there.”

    As unambiguous as that sounds, could it possibly be shorthand for:

    “If you really want to regain your health [by lowering your blood glucose levels, but you don’t want to try metformin or other oral medications, and you lack the willpower to change your eating habits or are not willing to monitor your blood chemistry to assure yourself that increasing the percentage of fat in your diet will not adversely affect your lipid profile], taking insulin is the quickest way to get there.” ?

    If so, I have to wonder whether this advice might counterproductively encourage newly-diagnosed T2Ds to postpone undertaking necessary lifestyle changes.

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