Insulin and The Challenge of the Needle - What are My Options?

When my father was first diagnosed with type 2 diabetes, there was a lot of prevailing ignorance as to what was best for extending a long and healthy life for the patient. Sugar was seen as the main culprit – with honey being a good substitute – while going on medications, or even insulin, was seen as some kind of dangerous failure. These fears and considerations kept him from making the best potential management decisions, and so he delayed getting on medications, and insulin. Had he gone on these sooner, perhaps he might still be alive today.

Despite best efforts being put forth toward education, many of these old fears and ignorance still abound, keeping some patients from making the best management decisions.

The Most Common Reservations are Usually:

• Fear of Needles: Sometimes, it takes a lot of self discipline for a person to overcome their fear of needles, much less their fear of self-injecting. If one has a family or friend who can help, it’s a little easier, but not all of us have that luxury. Needing to take multiple injections a day can put patients off of considering injectable medications.
• Fear of Side Effects: Some injectables may come with some undesirable side effects, such as potential hypoglycemia, weight gain, or cardiovascular or kidney complications. These might be scary considerations for persons who are already facing a long list of potential complications.
• Cost of Medications: Modern injectables, and modern insulin mixtures, often come at a very high out-of-pocket cost – even with insurance. For many patients, particularly elderly patients on a budget and with Medicare, this might be an obstacle to better management.

The Story Behind Injectables:

• Insulin: Of course, the most common and oldest injectable, Insulin, is a hormone which the body makes in order to aid in our digestion process – allowing for glucose to enter our blood cells and muscle tissues, as well as storing fat, and aiding in other metabolic processes. We are most often prescribed insulin when our bodies have stopped making enough insulin, or when the insulin we do make is simply not effective enough. Because a patient who injects insulin might be likely insulin resistant, injected insulin may have the unwanted side effect of weight gain, if diet and exercise are not carefully managed. Insulin may also contribute to hypoglycemic events, which may necessitate eating on a schedule, and being mindful of having appropriate snacks, or glucose gels and tablets on hand. Insulin often needs to be injected twice to several times a day.
• GLP-1 Receptor Agonists: There are some injectable medications which act by mimicking the action of incretins, a hormone which prompts the pancreas to produce more insulin when there are higher levels of glucose in the system. The medications also prevent the pancreas from producing too much glucagon – a hormone which prompts the liver to release stored glucose into the bloodstream, and by slowing down the rate at which the stomach empties after eating. These drugs have a lower incidence of hypoglycemia, and help patients feel fuller and more satisfied, leading to less overeating and weight loss. Another advantage with these injectables is that they only need to be injected twice a day, and may be complimented with other oral agents. The challenge, however, is that they may be pretty tough on the stomach, and lead to nausea; as well as being pretty expensive, even with insurance.

Creative Solutions in the Horizon:

The FDA has recently approved medications which may present a positive solution, or compromise, between some of the benefits of these injectables and patient hurdles. These medications come in the form of a combination between a GLP-1 agonist and insulin. Trials for these medications have shown that combining a GLP-1 agonist, plus insulin, may not present a higher risk of cardiovascular issues, and may help…

• Reduce hypoglycemic incidence
• Reduce the effects of nausea
• Reduce the need for multiple daily injections
• Reduce multiple costly out-of-pocket expenses, since there would only be one copay
• Sustain weight, with even some added potential weight loss
• Reduce patient hesitance

Of course, these medications are still in the working stages of best marketing – what their dosage limitation might be, and the best patient demographic target – but they present a potential new field in the world of diabetic tools in the warfare arsenal against diabetes.

Thanks to the diabeTribe Foundation, I was a part of the Open Public discussion for these medications, and I traveled all the way to the FDA and spoke on behalf of persons with diabetes – and the need for better management tools. In my next post, I will be happy to share some of my experiences.