August Blog: Insulin…Really??!!

Cindy, a 52-year-old female who has had type 2 diabetes for the past10 years, is preparing herself for an upcoming office visit with her primary care provider.  She feels both anxious and guilty for not better managing the day to day needs of having diabetes as well as she would like to do. Like so many others living with diabetes, life gets in the way.  Diabetes has become another “to-do” item on her daily list that makes her pull the sheets back up over her head each morning – fighting to get started.  Cindy wonders out loud, “am I alone?”  Lately, she has been afraid to check her glucose assuming in advance it will be “bad.” 

The day arrives for her office visit and she thinks, “okay, I can do this.” The visit begins and she waits in anticipation for the “finger stick” to get her hemoglobin A1c and glucose check.  The finger stick is not too bad this time.  As her primary care provider enters the room, she is friendly and shows genuine concern for Cindy.  Her provider shares her glucose is 300 mg/dL and hemoglobin A1c is 10%.  What??!! How could it be??!! She has taken her three oral diabetes medications (metformin, glipizide and sitagliptin) almost all of the time.  She begins to cry as a wave of guilt, exhaustion and shock overcome her.   Her provider reassures her and allows her time to let her tears fall. After a few minutes, they have a discussion of next steps.

Cindy is not alone. Many people are living the high demands of day to day life events while managing the daily realities of diabetes self-care.   Unfortunately, for persons with type 2 diabetes, for far too many years, insulin was used as a weapon of intimidation and a tool to threaten “compliance” to diabetes self-care.  Today, we have made much progress in the understanding of diabetes and know that insulin as a medication is part of the process for many persons with diabetes – especially those with insulin deficiency.  Those with type 2 diabetes requiring insulin medication have done absolutely nothing wrong, rather their body has lost the ability to make sufficient amounts of insulin to support insulin demands of the body.  Yes, more work is essential to remove the stigma of insulin therapy for persons with type 2 diabetes.  

As it turns out, Cindy’s provider ordered a c-peptide (a test that measures the body’s ability to produce insulin) to further assess CH’s ability to produce insulin.  Her c-peptide result was < 1 ng/mL indicating her body cannot produce sufficient insulin to match her body’s needs.   Also, her provider ordered a professional continuous glucose monitor so together they can see the trends in her glucose over a fourteen-day period to determine the most appropriate lifestyle changes and insulin regimen.

In the meanwhile, Cindy and her provider together develop a medication regimen which includes insulin and a couple of additional medications to match her body’s needs.  Before leaving, her provider schedules Cindy an appointment with the diabetes care and education specialist to provide ongoing support and education for her.  On the way out, Cindy meets her diabetes care and education specialist who greets her with a warm hello, words of encouragement, her business card, and asks her to call prior to her appointment if she gets overwhelmed with her diabetes.

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