There is one word that strikes fear in the hearts of every diabetic that I have ever diagnosed in my office.
One word conjures up images of needles, syringes, blood, pricking yourself day in and day out, chasing high blood sugars and low blood sugars to avoid the dismal future of uncontrolled diabetes. This word, as you already have guessed, is insulin. We avoid this word in practice because patients liken it to be given a terminal disease as though we have told them, “There is nothing else we can do for you at this point in your disease, so we regret to inform you that you must start insulin to save your life.”
Currently, physicians have big organizations that advise them on when it would be best to start insulin therapy for Type 2 diabetics. Type 2 Diabetics used to be called ‘adult onset diabetics,’ but that was when 50 year olds used to be the bulk of the newly diagnosed. Now, with more and more teenagers being diagnosed with Type 2 diabetes, we can no longer use the words ‘adult onset.’ Based on some guidelines, if you were diagnosed before the age of 30 or if you have had diabetes for over 15 years, should you have been considered for insulin? My bet: most of the people you know who meet these criteria are likely not on insulin.
Well, physicians are humans too. They don’t want to start you on insulin just as much as you don’t want to take it! Ok, maybe patients win on this tug-o-war in real life, but you get the point. Here’s an interesting excerpt from Diabetes Health magazine:
“The overwhelming majority of Type 2s eventually require insulin to obtain or preserve satisfactory glucose control and an A1c of 7% or less [see below explanation of A1c]. Research clearly shows that achieving good control early on prevents diabetic complications, including nerve, kidney, eye and heart disease, up to twenty years later.”
Deciding exactly when to begin insulin therapy is problematic for physicians who treat type 2 diabetes. Patients’ misguided fears about needles, hypoglycemia, and weight gain often lead to reluctance and physician inertia. A recent survey found that fewer than half of all physicians made any change in diabetes therapy even for patients with A1c’s of over 9%. A similar study at Johns Hopkins found that it took an average of 240 days before doctors added insulin or another drug for patients who could not achieve good control. By the time they finally took action, two-thirds of their patients had A1c levels approaching 10%.
How depressing is this for diabetic readers! Luckily, Integrative Medicine does not take insulin sitting down- literally! It is well known that 95% of Type 2 diabetes is caused by poor lifestyle. That is to say, that 95% of why teens and adults with Type 2 diabetes get the disease is because they choose unhealthy ways of moving (or lack thereof), unhealthy ways of eating, and unhealthy ways of managing stress. Changing lifestyle is just as powerful as any drug, even as powerful as insulin and we see this every day in our office.
Just this last week, my physician assistant Karen, was jubilated after seeing the latest blood work of a patient with whom she had been treating with therapeutic lifestyle change. This 40+ year old woman came in with vague complaints and was found to have horribly controlled diabetes through her initial labs. Her HgbA1c was 10.9. By the way, HgbA1c is a 3-month test score of how your blood sugars are running and the goal for diabetics is less than 6.5%. Based on her A1c, we should have started her on insulin per guidelines. However, she accepted that her lifestyle was less than optimal and she agreed to make radical changes in order to avoid insulin. Now, let’s just stop here and talk about something. Whenever someone gets in trouble or faces a dreadful prospect, there is some sincere bargaining that soon starts. When this patient agreed to change her ways, we were happy but not blissfully ignorant. We were on her to be sure her promises were not hollow. We initiated a rigorous detoxification program followed by a strict low glycemic index, anti-inflammatory diet to help treat the underlying cause of her diabetes. We followed her blood sugars closely until she was in a safer place. Her latest A1c was under 7, using just one oral diabetic medication plus a whole lot of healthy living. Let me put this into perspective- if she would have been diagnosed and managed by the standard medical approach as it is practiced today, she would have been placed on 2, if not 3, medications easily and still might not have avoided injecting insulin at the end of the story. Back in our world, she loses weight, feels better, has less aches and pains and her associated fatty liver disease is on the mend. That is therapeutic lifestyle change in all its glory!
Insulin is a powerful and necessary drug for many patients, however, it is avoidable for many Type 2 diabetics if they are willing to change their lifestyle. Until the medical community puts the appropriate emphasis on really teaching patients how to avoid or treat diabetes with proper lifestyle, we will continue to need more and more medications like insulin in our medicine cabinet. Good lifestyle is a daily practice of discipline requiring guidance by experienced lifestyle medicine providers. An easy measuring stick for anyone giving you lifestyle advice…are they practicing what they preach and working to live their healthiest life? If not, move on and be inspired by someone who does.
Dr. Shilpa Saxena MD
Dr. Saxena served as CEO for her SevaMed Institute practice, internationally known for contributions to the lifestyle-based group medical appointment model. She also founded the Center for Living Wellness and was chief of medicine for the n1Health physician network.