Sugar Matters
May 30, 2008
The case for insulin

I hope everyone is doing well and ready to move on! This week we will discuss some scenarios where your doctor will opt for insulin as your medication:

Reason 1 – you have Type 1 diabetes. As you recall, diabetes pills need some insulin around in order to work, or they themselves act to make insulin. But if your poor pancreas has no more cells to make the insulin, no amount of whipping with a pill will do anything.{{more}} Insulin is your answer. Keep in mind that ADULTS CAN HAVE TYPE 1 DIABETES as their new diagnosis; it is not only found in children. There may be other reasons besides Type 1 diabetes for an adult to be making little or no insulin: damage to the pancreas after years of irritation from alcohol is a prime example.

Reason 2 – Your pills are not working anymore. This situation usually arises when some people have had diabetes for some time, and their pancreas simply is not making much insulin anymore, “burned out” as some doctors say. One medication used to work fine but now you need three and your sugar is still not good-this is a point when your doctor has to move you to insulin.

Reason 3 – Severe insulin resistance. This is a tough state to fully understand because here you are producing lots of insulin, but the job is not getting done. It is like trying to speak to someone who is hard of hearing: you are shouting at the top of your voice but they can’t hear you. But maybe if you AND your neighbour shouted, they would hear you and respond. Same thing here-your pancreas is making a lot of insulin but your body just won’t react the way it should. So sometimes you need some extra insulin to get over the hump and get the response you need. Often in these situations of severe insulin resistance, folks do best with combinations of insulin and pills.

Reason 4 – You cannot tolerate any of the pills. If you have concerning reactions to the diabetes pills then insulin is your only option. Some of you are saying, “I’ll take the rash and liver problems, don’t put me on insulin.” Nice try, not a good option.

Reason 5 – You have other illnesses that stop you from safely taking pills. Examples include kidney failure, severe heart and liver problems. Also, sometimes when we are severely ill, our pancreas and own insulin do not work as well, so you need extra insulin to get over this situation until everything goes back to normal.

Reason 6 – Diabetes in pregnancy. We are gathering information about pills, but we know for sure that insulin works and does not hurt your baby.

Truly, if you are all torn up about starting insulin, be sure to have a long talk with your doctor about WHY you need it. Perhaps hearing a full story will make you feel better about it.

Until next week, Vincies!

Anita Ramsetty, MD
[email protected]
Medical Director Endocrine Care Group
Tel: 843-798-4227