Tuesday, November 13, 2012

Insulin resistance , a different perspective" inbrainertia"

Insulin resistance , a different perspective

The usual perspective.
Most people with type 2 diabetes are familiar with the term insulin resistance.  Insulin resistance is commonly associated with obesity.

 Wikipedia defines "insulin resistance" as a physiological condition in which cells fail to respond to the normal action of the hormone insulin.
            Fat and liver cells require insulin to absorb glucose.
            Liver cells respond to insulin by decreasing its secretion glucose .
            Insulin resistance also decreases the the storage of triglycerides in fat cells.

 The combination of insulin resistance and insulin deficiency is called Type 2 Diabetes

The different perspective  " inbrainertia "
We recently discussed the idea of treatment inertia. Treatment inertia is basically a form of insulin resistance that begins in our minds of patients with type 2 diabetes and their doctors. People with Type 1 Diabetes , especially children, are also victims of this form of insulin resistance.
The failure on the part of patients and their doctors to fully accept the reality of insulin deficiency and the need for insulin replacement comes with an often silent cost to their lives. Primary care doctors are  often slower than specialist in recommending insulin. Many patients are even more resistant to the idea of starting insulin.

In a recent continuing education class, Dr. Rubin reviewed data now in press for Diabetes care.
 Medication non-adherence is associated with a 58% increased in all-cause mortality

Another article pointed out  ;
 57% of patients with type 2 diabetes are very worried about having to start insulin.
                   Diabetes Care 2005;28:  2673-2679

Patients have many reasons for resisting the idea of starting insulin including;
   * My diabetes is worse
   * I failed to follow my doctors recommendation on diet and oral medications
   * Insulin won't help
 None of the above are correct .
 Type 2 diabetes is associated with a progressive loss of the ability to produce adequate insulin over time. There is hope that some of the newer diabetes medication will slow this process.

Other concerns include;
    * Fear of pain
    * Fear of hypoglycemia
    * Embarrassment
    * life style changes will be needed

All of the above are real concerns for every person with diabetes. I also know that the above concerns are over shadowed by the reality of diabetes silently stealing precious moments of our lives

Most of us have lived long enough to experienced some of the challenges life provides. The health problems most of us face are not by choice but we are often guilty of enabling the disease process. This is especially true for people with diabetes.

My approach to health issues has been framed by lessons I learned from my patients.

The practice of medicine is a rare privilege , allowing physicians to share moments in peoples lives when the "chips are down" and the reality of a situation requires a decision. I have had the privilege of observing the frailest persons make make some of the toughest decisions involving their loved ones or themselves.
These experiences helped me realize that every one of us has the hidden inner strength and courage that will rise to the surface to do what every is necessary when" chips are really down".

Well !!!
When you have diabetes , " the chips are down",  and it is time play the game .

Have fun , Be Smart  and take your insulin and don't be a victim of "Inbrainertia "
David Calder,MD


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Your comments and questions are appreciated. David Calder,MD