Diabetes Diabetes Treatment

A Passage to Insulin: Natural Progression or Failure?

Even though diabetes is on the rise, insulin therapy—the cornerstone of treatment—is still viewed with a mix of fear and wariness by many primary-care doctors and patients. But endocrinologists, who specialize in diabetes, warn that waiting too long to begin insulin therapy, is a bad idea for people with type 2 diabetes, who can go on to develop heart disease, kidney disease, blindness and other serious medical problems.

"People have some very negative ideas about starting insulin therapy," says Matthew Riddle, MD, a professor of medicine in the division of endocrinology, diabetes and clinical nutrition at the Oregon Health and Science University in Portland. "But insulin treatment really allows people to feel well again and, if it's done early enough, it will protect against diabetic complications."

Too Much Sugar
Type 2 diabetes occurs when the body's cells become resistant to insulin, which is the hormone that controls blood sugar levels. The body's ability to secrete insulin is also impaired, so the increased need for blood sugar regulation cannot be met.

A person's diabetes treatment strategy will depend upon how high their blood sugar levels are and whether they are experiencing symptoms such as thirst or frequent urination. While some people may require insulin therapy right away, others may be able to bring down their blood sugar levels with lifestyle changes, such as exercise and a healthy diet.

But Dr. Riddle cautions that the lifestyle modifications people manage to make are often not dramatic enough to control their blood sugar levels. If lifestyle changes aren't working, oral medications—which are more convenient and require less effort than insulin therapy—are the usually first step in drug therapy for diabetes.

There are different types of oral medications and each type improves the body's secretion of its own supply of insulin. The sulfonylureas stimulate the pancreas to make more insulin; the biguanides help the liver respond better to insulin; the thiazolidinediones make other parts of the body more sensitive to insulin; and the alpha-glucosidase inhibitors delay the absorption of food after it's eaten in order to blunt the blood sugar rise that can occur after meals.

Missing Out Due to Misconceptions
While oral medications, taken alone or in combination with each other, can control blood sugar for years, in most cases the disease eventually progresses. The pancreas no longer releases sufficient amounts of insulin, and blood sugar levels rise to unacceptable levels. Insulin therapy, which is usually given by self-injection, is typically recommended by the time someone has taken oral medications between 10 and 15 years.

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