Top Ten Reasons not to start insulin therapy   (September 5, 2007)

We recently were eating out with friends, one of whom has type 2 diabetes. He mentioned that his fasting glucose is rarely below 150, and my wife asked him why he hasn't started insulin. He hemmed and hawed, and finally mumbled that he didn't want to.

So, there's yet another reason not to use insulin therapy, and it led me to speculate on the top ten reasons not to use insulin to control diabetes. Here's my list:

• TEN: Aunt Tillie, who was blind and whose kidneys had failed, started insulin shots and died soon after. [Aunt Tillie should have started insulin years ago, before she got devastating complications. Had she controlled her diabetes all along, she may have had less complications and perhaps lived longer.]
• NINE: I don't want to have to go to restaurant bathrooms and "shoot up" and have others wonder if I'm a drug addict [By using an insulin pen and injecting through clothing, it's a snap to give a shot anywhere: restaurant, automobile, or wherever. It can be done in less than 20 seconds every time.]
• EIGHT: Insulin isn't natural - it's synthetic. [Agree. Most insulin products now-a-days are made by chemistry, and no longer extracted from pig or beef pancreases. So what? It's a heck-of-a-lot purer than it used to be: until about 1972, the stuff people used was 90% insulin and 10% impurities; it's now 99+ pure insulin, identical to human insulin, and allergic reactions are almost unheard of.]
• SEVEN: Disposing of insulin needles is necessary to avoid addicts getting a hold of them [True! You should dispose of your needles as local regulations require. Ask your physician or diabetes nurse educator what's the best way for you to do so.]
• SIX: Using a new syringe every time, or needle on the insulin pen, is expensive. [But it's unnecessary. Most folks reuse their lancets for finger-sticking, and reuse their syringes and insulin pen needles, several times.]
• FIVE: I'm afraid of hypoglycemia. [True, hypoglycemia is fairly common with insulin therapy, but with frequent blood sugar testing, and using newer insulins (once daily Lantus or basal-bolus insulin if on more than one shot per day), it's a reasonable trade-off for better diabetes control.]
• FOUR: Taking insulin shots means I've failed at controlling my diabetes. [No! Type 2 diabetes is a progressive disorder, and eventually the beta cells of the pancreas will no longer be able to make sufficient insulin, no matter how hard you've worked at managing your diabetes.]
• THREE: Insulin makes you gain weight. [True. Insulin is a storage hormone, and converts incoming calories to fat, so if you eat too much, you will gain weight.]
• TWO: The shots hurt. [Sometimes true, but everyone agrees much less painful than finger-poking for blood sugar testing!]
• And the NUMBER ONE REASON not to take insulin: I don't want to. [Can't beat this one. It's your life, and your decision.]