I was lucky enough to be invited to attend the Johnson & Johnson Diabetes Institute in Milpitas, California at the beginning of April.  The Institute is a 2 day intensive diabetes education/training session to help Diabetes Educators, Nurse Practitioners, Physician Assistants, & other Health care providers find innovative answers to to some of the challenges facing diabetes care.  Topics ranged from Insulin Pump Therapy to Continuous Glucose Management to Reimbursement issues to Behavioral Change Techniques.  Overall, the session was very enlightening for me.  I was able to meet with Diabetes Educators from around the United States and share ideas on improving diabetes care. 

One session I really enjoyed involved the topic of diabetes medications.  With Type 2 Diabetes, the patient is usually diagnosed some time after diabetes has developed. Treatment is normally started with oral medications (pills) along with lifestyle & diet change.  Insulin is usually a last-ditch effort to improve blood sugar control.  However, Type 2 Diabetes is a progressive disease.  When Type 2 is diagnosed, many years may have passed since the patient truly developed the disease.  In that time, the pancreas may have already maxed out its insulin production.  What that means is that insulin may be needed sooner than would be expected.  What that also means is that insulin starts should not be seen as patient “failures”.  The nature of Type 2 Diabetes progression will eventually lead to that, regardless of overall control.  Therefore, it is important to at least start talking about insulin use soon after the diagnosis is made.  There is no question that initiating insulin brings up many fears in patients and providers alike.  But if you look at the types of insulin that are available today, we have significantly more choices and options than we did just 10 or 15 years ago.

Insulin is a medication that could be considered much more natural than its oral counterparts. Insulin is simply a hormone made by the pancreas to help the body utilize energy.  With insulin, you may run a higher risk of having hypoglycemic (low blood sugar) episodes but those can be minimized.  In fact, some oral agents are contraindicated in geriatric patients or those with kidney, liver or heart disease.  There is less risk to the liver and kidneys with insulin as it is not excreted through these organs like many of the oral agents.  A major benefit to using insulin is that it allows you to tailor your approach to blood sugar control.  It gives you the opportunity to fine tune adjustments and get exactly what you need, when you need it.  Of course, when using insulin you must still balance between exercise and proper food intake to get the maximum benefit! 

We need to make sure that we don’t view the use of insulin as a failure.  Insulin should be used more freely as a means to achieving better blood glucose control earlier on in the treatment of diabetes.  Once on insulin, we would encourage more frequent blood glucose testing.  This gives the patient instant feedback on how his or her therapy is progressing.  We have multiple tools available to us.  We must use them more efficiently.

If you are not meeeting your diabetes health related goals, talk to your physician about the possible use of insulin.  There are risks and benefits associated with any medication change, but if it enables you to control diabetes better, the benefits will far outweigh the risks. Take control of your diabetes!

It’s Your Health!  It’s Yor Life! Make That Change!

Johnикони