INSULIN, THE BOGEYMAN

by Peter J. Nebergall, PhD

This week, I've heard the same thing from a number of diabetics, and I am horrified. I really thought we knew better. What did they say?

With different words, it was all the same thing: How much they wanted to get off insulin. They were determined! Never mind the damage to my control, just get me off those needles! They saw insulin, not hyperglycemia, as the enemy—the bogeyman.

Why is this? why are some folks willing to gamble with their health, willing to triple the risk of serious complications? Some of it is plain old "fear of needles," of course. Some time ago I wrote: "Many men would rather face a bayonet." The same way some otherwise mature adults put up with excruciating toothache rather than call the dentist, who'll fix it, some folks put up with poor control and high blood sugars, rather than "face the needle." Now high BG's aren't as immediately painful as a toothache, but they can kill you a lot quicker! If you're running from the needle, where are you running to? I'll tell you...

Diabetes is not particularly mysterious. The better your control, the less your risk of complications. The Diabetes Control and Complications Trial (DCCT) proved this, pretty conclusively. High blood sugars are the root of all evil here— and the better job you do of "walking the straight and narrow," keeping your numbers as close to the non-diabetic "normal" as possible, the less your chance of complications. It's not an exact fit, of course, but how you achieve tight control is of far less account than that you do it—and if insulin is what it takes, then to do anything less increases your risk of diabetic neuropathy, nephropathy, retinopathy, and those fun things.

But Some Folks are Lucky

Some type 2 diabetics will eventually need insulin. Their diabetes, caused by insulin resistance rather than insulin insufficiency, leads to the same kind of high blood sugars, and can cause the same complications, as type 1 diabetes, but the rules are a little different. What about that insulin resistance? If you have the genetic tendency for type 2 diabetes, being inactive, or overweight, or an incautious eater, (or all of the above) may push your blood glucose numbers up to where oral medications, or insulin, are needed. Losing the weight, starting and keeping a good exercise program, and shifting to a moderately-sized healthy diet may cut your need for medication. A few folks, adopting the necessary lifestyle changes, may be able to discontinue medications, BUT THAT'S NOT THE POINT. The point is to get those numbers where they need to be, and keep them there. If "lifestyle modifications" do the job, great. If it takes insulin, then that's what it takes. The diabetic who progresses from oral medications to insulin is neither "getting sicker," nor is he/she "a failure." The need for insulin is a normal response to the disease process—not a value judgement.

Insulin is not the bogeyman. Just as the drive to the dentist's office is the most unpleasant part of the visit, anticipating giving yourself that insulin injection can be the most difficult part of self-management, until you get used to it.

High blood sugar is one bogeyman. Like a cannibal termite, excess sugars chew away at the circulatory system, the kidneys, eyes, and nerve fibers. You don't feel pain until the floor falls out from under... Fear is the other bogeyman. He lives in that murky area called "I don't know..." When we learn what we should be doing, we chase him away.