Wednesday, October 6, 2010

Insulin for Type 2 Diabetes: The Australian Guidelines

Insulin is the one treatment for diabetes that always, at least eventually, lowers blood sugar levels, although some diabetics require more than others. It's always injected. There's no way you can get it in a pill.

Many diabetics erroneously believe that having to take shots once a day or even up to four or five times a day is a sign of failure to manage their disease. It's not. It may actually be the first step to, ironically, not needing to take a daily injection in the future. Australian doctors are now being advised to offer their diabetic patients insulin sooner rather than later. Here's why.

Newly diagnosed type 2 diabetics are often advised to take sulfonylurea drugs that stimulate the pancreas to work harder to get blood sugar levels down. The problem with this prescription is that often, by the time someone is diagnosed with type 2, the pancreas just can't work as hard as it used to. Beta cells may have lost their ability to "unzip" the storage hormone pro-insulin into its active form, and often about half, up to 90 per cent, of these insulin-productive cells are already destroyed. It doesn't do any good to keep trying to stimulate something that isn't there.

That's where insulin injections come in. If the pancreas just can't make the hormone at all, shots actually will take care of the problem. Or if the problem is that the beta cells are just "tired," needing to overcome antioxidant stress so that they can resume efficient release of insulin, then maybe taking a shot once or more a day is what is needed to get back on track.

Australian guidelines call for doctors to offer insulin to any type 2 diabetic who is already on the maximum dose of "sugar pills" or sulfonylureas who has an HbA1C of over 7.0%. The Lantus usually prescribed is a "kinder, gentler" form of the hormone that works slowly and is very unlikely to cause hypoglycemia, even when mistakes are made in its use. Diabetics may also be given premixed insulins which help get blood glucose levels down right after meals and keep them down throughout the day and night.

And even if you are not in Australia, you can ask your doctor if this approach might work better for you. Not only is this the only medication that always works, it's also vastly less expensive than the latest drugs.

Selected Reference:

MacIsaac R, Cheung A, Jerums G.
Type 2 diabetes - controlling hyperglycaemia with early insulin use.
Aust Fam Physician. 2010 Aug;39(8):565-9.

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