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Insulin dramatically increases the life expectancy of persons with type 1 diabetes. Those with type 2 diabetes have also benefited from modern insulins. However, about a third of those with type 2 diabetes are unwilling to take insulin. Here's a few of the reasons that we hear for "psychological insulin resistance":
Due to the progressive loss of beta cell function in type 2 diabetes, most of those with type 2 will likely require insulin at some point.
Complications of uncontrolled type 2 diabetes are well documented. Type 2 diabetes is falsely perceived as mild.
Beginning insulin therapy indicates to some people that their diabetes is now more serious. People with type 2 diabetes often feel fine and may wonder why they should start insulin. The greatest barrier to starting insulin is the fear of gaining weight, but with lifestyle counseling the weight gain overall is modest.
Healthcare providers are also reluctant to initiate insulin therapy even when a person has a high A1C. The provider's attitude has a significant impact on the patient's attitudes and beliefs regarding insulin. Often, insulin therapy is used as a threat to force people to make lifestyle changes. Or, clinicians can use it as a scare tactic — a threat if the person with diabetes does not comply with prescribed oral agents. Labeling insulin therapy negatively makes people with diabetes feel like they've failed.
Recently, I had a patient tell me she didn't ever want to go on insulin. She wasn't starting on it, but when she repeated the statement I asked her why. She said she didn't want the hassle of having to give herself injections. I mentioned that when a person with type 2 diabetes needs to start insulin, they are often started on a once-daily long acting insulin injection. She was surprised, relieved and said that wouldn't be bad at all.
What are your thoughts?
Nancy Klobassa Davidson, R.N.
Peggy Moreland, R.N.
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I was diagnosed with type 2 over 10 years ago. Had a heart attack and quit smoking in 2010, ballooned to ~240 lbs. from ~200. Started on Insulin in 2011. Since then my appetite has been uncontrollable, I've jumped to 265 lbs., I'm impotent & my feet hurt worse than ever. I really need to explore Victoza and other non-insulin drugs that might help with weight loss instead of aiding it a la insulin. Oh- Metformin is a no-go for me because I'm on the edge of kidney failure. I get treated at the V.A. which is good at keeping you alive but isn't interested in *quality* of life. Whatever. I'm almost 61. I've written three books and thousands of articles. If I keel over right now I've had a good life.
Thanks for sharing Elizabeth and great going.
I definitely suffered from psychological insulin resistance until recently. Diabetic since age 19 (21 year ago), I have been jostled between type 1 and type 2 diagnoses. I had to be on insulin during pregnancy, which was ok, but also contributed to my concerns. So current understanding of diabetes labels me as a type 2 - which has been a huge factor in my psychological resistance. I have been made to feel like a failure for being overweight since I was a child, and no one disputed the ideas in my head that becoming diabetic was my fault. I spent many years being deeply ashamed. Insulin (with the exception of pregnancy) has been intimately tied to failure in my mind, until recently. Also, I have serious issues with low sugars and with the failure of friends and family to respect lifestyle changes, such as regularly scheduled predictable meals, necessary to make insulin therapy a good choice. I also experienced the dreaded weight gain with insulin, which fueled the vicious cycle of shame and a sense of hopelessness.
A need recently for neck surgery has changed my perceptions, happily. My PCP is very supportive and understanding, which has also made a huge difference. I have been on insulin for about 3 months now and was shocked and thrilled at the ease of use of insulin nowadays and with the huge benefits in dropping sugar levels. I feel so much better, even though I know we still have some fine-tuning ahead. Thanks for validating my feelings after all these yrs.
I was diagnosed with Type 1 at 23 years, I am now 43. I began an insulin pump within a year of my diagnosis. I have no complications of diabetes at whatsoever. Nothing. I attribute this to starting the pump so soon after diagnosis. I have always felt that type 2's were at a disadvantage because they use oral meds even after they become ineffective. The name of the game with diabetes is to acheive normal blood glucose. The best way for many people to do this is to use insulin. My advice would be to start insulin because it offers the best means to acheive normal blood glucose and remain healthy. Thats what we all need to do fight for our health. If you need insulin use it!
I was thrilled when my primary suggested an endocrinologist for my type 2...unfortunately, he could only suggest some very expensive alternate drugs and as I am under 65 and retired with no drug coverage, I had to decline...I started Atkins and lowered my own A1c to 6.5 but now its sneaking back up 8 months later...I feel like I am out "there" on my own...I learn all I can on the internet....there must be others like me, where are you??
I have been a Type ll for about 14 years. I have seen several doctors over that time and all have been very good except for one. He was very arrogant, crossed his arms and looking down at me said, "Diabetes is a downward spiral for the rest of your life. I'm willing to bet you will be on insulin in 6 months." That made me feel like going on insulin would be about the end of me. Thank goodness for all the kind doctors (all the others have been women doctors) and I'm still on oral medications but know that if and when I may have to go on insulin, I'm not a failure.
I have been a type 2 diabetic for many years & was put on insulin by a Dr who didn't know how to treat diabetes. My abdomen & thighs now look like a dart board & we won't even go there with fingertips. I use both long lasting & short acting insulin injections & still have a high A1C. I'm in tremendous body & spinal pain which no one can seem to identify so I'm sure that is why my blood sugars read high the moment I eat a carb of any kind. My way of life has been hell so if there is another way to handle diabetes, try that first. It isn't as easy as they want you to believe, however if it is the only alternative to death, guess we don't have a choice. You would think by now that someone would have found a cure for all the billions that have been pumped into research. Do I sound upset, you bet!
I have been giving myself B-12 injections for over a year. I was told B-12 must be given as an injectiona as at my age I am unable to absorb through a pill. Low B-12 can cause many problems. I cannot understand anyone not taking whatever, however medication that can control their problem. I would not want to start insulin and at this point my doctor says I am fine on 500mg of metaformin once a day. I am happy to say I lost 5lbs in the last month by cutting out bread and watching my carbs. Bottom line you do what you have to do. I have already lived to see 12 great grands but would like to be around to see a few more.
Yes, yes I understand all of the denial issues when it comes to Diabetes, whether you are Type 1 or Type 2. I had to make a big adjustment which was very devastating. Anyway the bottom line is that Insulin, Insulin pumps and Diabetes Care from an Endocrinologist is the blessing. We all got Diabetes as "Luck of the draw" today the insulin available is so superior to the olden days.
One more thing is that you don't have to be perfect, but to survive you have to embrace your diabetes. That means testing. The blessing is that we have the new insulins.
Just like there different severities of Type II diabetes, there are different severities of Type I. Some cases are almost immediately fatal, but other cases are not. All of you on here trying to talk about Type I need to understand what the actual difference between the 2 types is: Type I is when then pancreas does not produce enough insulin. This could be no insulin at all (the immediately fatal cases) or enough to live, but not enough to live well. Type II is when cells do no utilize insulin properly, usually due to insulin resistance. The distinction is the nature of the hyperglycemic symptom. In fact, most Type II diabetics have elevated insulin levels for several prior to diagnosis; their pancreas is fine and is in fact working overtime; the cells just aren't utilizing all the insulin properly. In Type I patients, there is a shortage of insulin; the cells can use normally, there's just not enough to go around.
I'm a type 2 diabetic who felt I had failed when I had to start on insulin. Doctors did use the scare tactics that you described.
But now I'm extremely grateful for insulin. It has given me tighter control of blood sugar, my HGA1C is in a good range, and even though I did gain weight, I've started losing now that I've come to grips with the need.
I know that type 1 diabetics need insulin daily or they will die, but I also appreciate it for my type 2 treatment with insulin.
It is possible to get over the needle phobia. Small children can do it; so can we old folks.
I'm working as a practice nurse at a general practioner office in the Netherlands and juist finished my masterthesis on psychological insulin resistance among patients with insulin independent type 2 diabetes. It is an unrecognized issue and the initial "no" to insulin hides a world of misconceptions and emotional distress.
My dad had Type-2 diabetes for years, and I can truly attest to the fact that insulin extended his life and, though a "hassle" at times, improved his health. Diabetes is a difficult disease to live with for everyone, but living in denial about the benefits of injections (simply because of the fear of packing on a few pounds, etc) is upsetting. But I suppose that's the general Western mind-set in most areas of health (IE- Why eat salad when cake tastes so much better? Why work out when I can sit on the sofa and watch American Idol?). Being healthy isn't immediately enjoyable the way a bowl of ice cream is, but it extends your life... and I'd say that's something to be enjoyed.
I've been diagnosed with pre diabetes. I take Crestor and high blood pressure medication. I also have a needle phobia. I can't even prick myself to check my blood sugar level. What if I have to inject insulin daily?
I feel people are over-reacting to the statement about
"insuling extending life", it is factually accurate. Think
about before insulin was invented. People with type 1-lived very short lives. I have type 2, and take approx. 5-6 injections per day. (rapid ins. with meals, byetta, and long lasting insulin at night) This is a "good" thing. I feel better and have good control. I am 55 years old, and I feel the prejudice exists among the previous generation--parents, aunts, uncles. They saw the horror of people suffering many years ago, but today the situation is much improved. People die from complications of diabetes, not diabetes itself.
To those disgusted w/ peggy's use of language. Dramatically increasing ones life expectancy can be interpreted to mean you will see another day, let alone your next birthday or 50 birthdays.
Life expectancy whether it is a day, week, year, or decades is just that- your life expectancy. dramatically increases? you bet, if it saves you from deaths door another day is dramatic.!
I can sympathize with those parents who almost lost their child,as my wife and I almost lost ea of our two children, in seperate instances, to different conditions unrelated to diabetes.
Parents should be educated to diabetes symptoms, and be observant of their childs behaviors. this is the first line of defense in arresting any medical abnormality in our children.
secondly, regular checkups at your pediatrician, some good outdoor activity, and healthy diets, are basic requiremnts of good parenting.
Please realize Nancy and Peggy are Registered Nurses and have training in bedside manners.
Mary - you are completely wrong. People with Type 1 will not live months or years without insulin. Many children are diagnosed literally at deaths door. You must have been lucky enough to have some advance warning of your condition. I have talked with many parents who almost lost their children to Type 1 diabetes before they were diagnosed. Once diagnosed, SOME people have minimal pancreas function for a matter of days or month after diagnosed. Many do not. How long would you last Mary if you stopped taking your insulin? You were diagnosed at age 9? I'd guess you wouldn't see 4 days. How sad that you continue the misinformation about this VERY DEADLY Type 1 diabetes.
Insulin dramatically increases life expectancy in Type 1 diabetes. Are you kidding me? People with Type 1 will DIE in a matter of hours without insulin. It's not just a matter of living a longer, fuller life with it. It is absolutely essential every minute of every day. I've only read a few of your blog entries, but I'm SO very disappointed. This blog is all about Type 2, but fails to state this. I can't believe that a blog associated with the Mayo Clinic would have such misinformation.
I am a 55 year old type 2 diabetic - diagnosed about 2 years ago. So far controlled with no medication. I am afraid that I may need to start medication at my next physical in Feb. Maybe it's a male thing, or a myth, but there is something about being on medication long term that bothers me. Maybe I think I can control it on my own. Thoughts?
""Insulin dramatically increases the life expectancy of persons with type 1 diabetes." This is a ridiculous statement. Without insulin, a type 1 diabetic will die." Dear "Annoyed", Your statement about dieing is absolutely true. However, one does not hear the diagnosis en die! A type 1 diabetic without insulin will die within several months to a couple of years;during this time he will suffer the (terrible) consequences of starvation and ketonuria. Therefore, insulin indeed dramatically increases the life expectancy and quality of life of persons with type 1 diabetes. I have been on insulin for more than 50 years and I literally had to be held down for my first injection (at the age of 9). That was the last time that it happened and I am thankful that I have been able to live my life as I have done. To all those who are dreading the "shots": compared to the 50's, the needles are shorter and thinner, the heavy glass syringe has been replaced with lightweight plastic or a pen, insulin is more dependable and produces fewer side-effects, the possibilities for blood sugar controle are enormous (45 minutes in a hospital lab back then, 5 seconds now), almost everything can now be obtained in a "sugar free" version and, in general, one just feels so much better It is tough te be positive when confronted with insulin injections; it helps to see the positive side of things. It is a lifestyle change and it will take time to adjust but i
Great job. Thanks for the information.
My thoughts...you should re-read what you have written and clarify statistics and refrain from general statements. Very disjointed writing.
I am a type 2 diabetic and over several years have taken different oral medications, some with severe side effects. For a time I used a bit of insulin along with pills and it was nearly as though insulin was a death sentence. Dropping pills and on 30/70, I feel so much better and my A1c is just over 7. I have gained weight though.
iam a type 2 diabetic i take three different kinds of insulin, humiln r,,humalin n hualog 40/60 it helps me a lot my sugars are near normal
When I was diagnosed 13 years ago, I had the hardest time with my diabetes management because I had a phobia for needles. To this day I still have a phobia for needles but with effective diabetes management techniques, I was able to go from insulin to oral meds about 6 years ago.
I completely can relate to the insulin issue from this personal stand point.
"Insulin dramatically increases the life expectancy of persons with type 1 diabetes."
This is a ridiculous statement. Without insulin, a type 1 diabetic will die. Injected insulin is life-support for type 1 diabetics. This sentence is wrong and misleading.
I expect better from the Mayo Clinic!!
Really a educative and informative post, the post is good in all regards,I am glad to read this post.
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