Yeah, except the artificial one doesn’t burn out and quit making insulin. Right?
And as Juliana sorta says, and from what I can tell by my reading, early and intense insulin treatment is more and more looking like one of the best treatments for Type 2s, as it preserves any existing pancreatic function. So really, my OP is meant for all insulin-using diabetics. I’m one of the lucky ones who went straight to insulin. Alas, diet, exercise, and weight loss doesn’t do it for everyone…
Interesting stuff. Still seems like end stage renal disease will continue to occur related to diabetes, since even small fluctuations in the blood glucose cause all kind of problems in the tiny blood vessels that innervate the kidneys and allow them to work. Diabetes is a tough disease, that’s for sure. I hope something promising like this will become a reality soon.
SubQ glucose monitoring is not all it’s cracked up to be yet, either. At present, it involves up to 8 to 12 fingersticks a day to correlate what the subQ monitor is showing compared to what a standard glucometer shows.
And pumps are a management tool and often a convenience, not a huge leap forward. They’ve been around since the 1980’s, and non-compliant diabetics have just as many problems with them as with standard therapies. I’ve several patients and a daughter with a pump, so I’m pretty aware of how they’re used and misused.
As for pumps in insulin-resistant folks, well, the pump provides more insulin, the body resists it, the pump supplies more insulin, the body resists it more, and pretty soon the individual is requiring massive doses of insulin. Same as with shots.
I’ve been working with pumps and insulin-monitoring for over 25 years now. They’re better tools than we used to have, but IMHO they are not a paradigm shift in how we manage the disease. Frankly I think the introduction of metformin was a bigger breakthrough, which has helped far, far more type II DMs.
So in theory, the idea of a continually adjusting insulin pump slaved to a continuously running glucose monitor is wonderful, but the reality is that it doesn’t translate into an artificial pancreas. Despite certain drug company hype to the contrary.
Early intervention with insulin for type IIs may indeed be better for select type II patients. But more data is needed, frankly, before we can say that is a given. Insulin itself is thought to be somewhat atherogenic (causing plaque to build up in arteries), so the medical community is still trying to sound out risk vs. benefit of all these approaches.
I don’t mean to rain on your parade, and I’m happy that better and better tools are being created. But I’ve been in the trenches of diabetic care, both professionally for over a quarter of a century and personally for nearly 15 years too. And the basics are still the same: If on (short acting) insulin, check your sugars frequently & take your insulin as required; count your carbs, get your exercise.
BTW, I’ve been hearing that the subQ monitoring would be the thing for all diabetics within 2 to 5 years, for over 5 years now.
Just curious, Qad - what do you suggest for massively insulin resistant types who don’t respond well to the various drugs that work on resistance, and who are as a result having to take massive doses of insulin? How bad is it to be taking a whole lotta insulin?
Also, what do you think of the insulin/weight issue? I’ve read quite a bit from people claiming their inability to lose weight is because of all the insulin they take, but most medical journals say that insulin, by itself, does not cause weight gain - it’s misuse of insulin to allow one to eat unhealthy food that causes weight gain. I’m having trouble sorting out what the straight dope is on that one.
Well, insulin does let folks who are morbidly obese get by with HgbA1C levels of 7 or lower, which is essentially excellent control of blood sugar. And tight control reduces risk, regardless of BMI.
And insulin along with weight reduction does increase the risk of more hypoglycemic episodes occurring as insulin needs change. Of course, the treatment for the episode is to take glucose. But it’s hard to stop from eating excessively when one’s glucose level is 40, & then afterwards, get back onto the diet.
But it can be done with frequent blood sugar checks, close carb counting, and appropriate exercise, and decent supervision by doctor or DM RN.
As for your first question about those taking lots of insulin: The bad effects of high doses of insulin (atherosclerosis) are mostly theoretical and in the future. The bad effects of not taking enough insulin are well-demonstrated and in the present & near future. So if one needs more insulin to achieve target blood sugar levels, more insulin should be taken.
So you don’t buy into the whole “I take insulin, that’s what makes me fat and it’s impossible to lose weight when you take insulin” schtick that I see all over the diabetes forums? I think the idea is that insulin somehow makes it easier for your body to make fat, and also taking a lot of insulin makes you hungrier. I don’t think they’re talking about going low and having to eat carbs to get their sugars back up, it’s something about the insulin itself that they say makes them fat.
My gut feeling (and what I read) is that they are simply used to eating more than they should because of the diabetes, and once their blood sugars are back in line they don’t adjust their diet to compensate for that. But I’m not a doc, and I’m wondering if there’s any truth to it.
Statistically, most type II DMs who go on insulin will gain weight. That’s a fact. I expect part of it is from having more of their glucose get taken up by the cells rather than exiting the body via the kidneys. I also expect part of it is due to occasional hunger from low blood sugars. And another part is due to having an insulin regimen established which gives good glucose control, but has too many calories in it. So yes, I expect your gut feeling plays a role in the equation too.
It truly does seem to be harder to lose weight while on insulin. But then again, weight loss is never real easy, especially for folks who tend to get type II DM.
Interesting. Thanks for the answers. There’s just so many factors in this whole thing, it’s hard to get it all straight.