Insulin Isn’t Punishment

After more than 20 years of living with type 2 diabetes that was sometimes well controlled, other times not, Renee Stanton arrived at a crossroads in October of 2010. An A1c test at a Taking Control of Your Diabetes (TCOYD) Conference in San Diegorevealed a reading of 11.6; her average daily blood glucose for the previous 90 days was around 280. It was high time to get her diabetes under control, or face serious consequences.

Fortunately for Stan-ton, she was one of seven people with high A1c scores at that conference who were chosen to participate in TCOYD’s “Extreme Diabetes Makeover,” a 20-week program of intense diabetes therapy headed by Dr. Steve Edelman, TCOYD’s founder. “Extreme Diabetes Makeover” involved weekly or more frequent sessions with a diabetes “Dream Team,” including Edelman, an exercise physiologist, a CDE, a nutritionist, and Dr. William Polonsky, one of the leading clinical psychologists focusing on people with diabetes.

Edelman’s first step in helping Stanton take control was to look at her morning blood sugars and at what time she took her blood glucose-lowering medications. “We put her on Byetta right after the conference,” Edelman says, “Because she was fighting weight problems and her glucose levels after eating were in the upper 200s, I increased her metformin dose to 1,500 mg at bedtime. Sometimes just shifting the dose to nighttime helps the morning blood sugar. ” Edelman also increased Stanton”s glipizide dose to the maximum. The new medication and dose increases helped, but after a few weeks, her daily morning readings were still too high. It was time to take long-acting insulin at bedtime.

“ Increased exercise and modified diet are unlikely to completely control diabetes in a type 2 with consistently elevated glucose levels. ”

Stanton wasn’t afraid of the shots — both Byetta and insulin required daily injections — but she viewed her need for insulin as a personal failure. For years, her previous doctors had portrayed “going on insulin” as a last resort — the punishment for being a “bad diabetic.”

Polonsky, founder of the Behavioral Diabetes Institute, got her to look at insulin differently. “Many type 2s think insulin is only for people with type 1 diabetes,” he says, “and don’t understand that if you have diabetes long enough, you’re likely to need it at some point in your treatment. With type 2s in particular, the pancreas is likely to poop out, because it keeps making insulin that isn’t used and thinks it needs to make more. Insulin doesn’t mean that you’ve failed.”

In fact, behavioral changes such as increased exercise and modified diet are unlikely to completely control diabetes in a type 2 with consistently elevated glucose levels. Job One is to get the average glucose down, so that behavioral changes can have the desired effect. This means that more and more type 2s will be put on insulin sooner rather than later.