Diabetes and Insulin
Updated June 08, 2015.
Insulin, secreted by the pancreas, is a hormone that helps glucose move from the bloodstream and enter the cells of the body. Glucose uptake, as it is called, is critical because glucose is the primary source of energy for the cells of the body. If a person has insufficient insulin, blood glucose levels will rise to abnormal levels, which over time can damage organs.
People who have this condition require extra insulin to overcome the resistance and to maintain normal glucose levels in their blood.
With type 1 diabetes, most of the insulin-producing cells in the body (the pancreatic beta cells) have been destroyed. This limits the amount of insulin available to use or store glucose from food. As a result, all individuals with type 1 diabetes need to take supplemental insulin to control their blood glucose levels.
With type 2 diabetes, the pancreas may still produce insulin, but several situations can occur. The pancreas produces insufficient amounts, or the body resists the insulin or doesn’t make optimal use of it.
Diet, exercise and various oral medications can help the body use its self-produced insulin more efficiently. For this reason, supplemental insulin is less often required to control type 2 diabetes, especially at earlier stages of the disease. In fact, according to the CDC, only 28% of those with type 2 diabetes take insulin.
However, there’s a catch. Type 2 diabetes is a progressive disease, meaning the beta cells deteriorate over time. Eventually, actual insulin therapy -- via injections, insulin pen or insulin pump -- may become necessary.
Some health care professionals think that patients with an A1c over 7% should be on insulin if they are not responding to oral drugs or a new class of drug called GLP-1. If a patient’s Hgb A1c is over 7%, he or she may want to ask a doctor how to reduce it to below 6.5% or 7%, the levels targeted by the American Association of Clinical Endocrinologists and the American Diabetes Association, respectively.
Dr. Richard M. Bergenstahl, executive director of the International Diabetes Center in Minneapolis, thinks that more people with type 2 diabetes should take insulin. Insulin may be the oldest treatment for diabetes, but it remains the most effective for those with high Hgb A1cs that can’t be reduced by other means (oral drugs or GLP-1 based therapies).
Unfortunately, many people with type 2 diabetes avoid taking insulin because they perceive it as some sort of a personal failure. It is not. As time passes, anyone with type 2 diabetes will suffer an increased loss of beta cell function, and at some point insulin will be required. The problem is with the disease, not the patient. If a person needs insulin to maintain normal glucose levels, it should be taken.
Sources:
"National Diabetes Fact Sheet." National Center for Chronic Disease Prevention and Health Promotion . 09 June 2005. Centers for Disease Control and Prevention. 10 Sep. 2007. <http://www.cdc.gov/diabetes/pubs/factsheet.htm>.
"Type 1 Diabetes." Diabetes.org. American Diabetes Association. 10 Sep. 2007. <http://www.diabetes.org/type-1-diabetes.jsp>.
"Type 2 Diabetes." Diabetes.org. American Diabetes Association. 10 Sep. 2007. <http://www.diabetes.org/type-2-diabetes.jsp>.
"Overcoming Clinical Inertia in Diabetes Care." Physician’s Weekly. 11 June 2007. Physician's Weekly. 10 Sep. 2007. <http://www.physweekly.com/article.asp?issueid=470&articleid=4391>.
Donath, Marc Y., Jan A. Ehses, Kathrin Maedler, Desiree M. Schumann, Helga Ellingsgaard, Elisabeth Eppler, and Manfred Reinecke. "Mechanisms of Beta-Cell Death in Type 2 Diabetes." Diabetes Dec. 2005 S108-S113. 12 Sep. 2007. <http://diabetes.diabetesjournals.org/cgi/reprint/54/suppl_2/S108.pdf>
"Insulin Myths and Facts." Clinical Diabetes. Jan. 2007. American Diabetes Association. 12 Sep. 2007. <http://clinical.diabetesjournals.org/cgi/content/full/25/1/39>
Insulin, secreted by the pancreas, is a hormone that helps glucose move from the bloodstream and enter the cells of the body. Glucose uptake, as it is called, is critical because glucose is the primary source of energy for the cells of the body. If a person has insufficient insulin, blood glucose levels will rise to abnormal levels, which over time can damage organs.
What Is Insulin Resistance?
Insulin resistance occurs when the cells in the body become insensitive to insulin.People who have this condition require extra insulin to overcome the resistance and to maintain normal glucose levels in their blood.
What Is the Difference between Type 1 Diabetes and Type 2 Diabetes?
Type 1 and type 2 diabetes are conditions in which insulin cannot properly move glucose into the cells for energy, either due to a lack of insulin or due to cellular resistance to insulin. This creates two problems: high blood glucose levels and a depletion of stored glucose, the body’s major fuel source. The causes of type 1 and type 2 are different.With type 1 diabetes, most of the insulin-producing cells in the body (the pancreatic beta cells) have been destroyed. This limits the amount of insulin available to use or store glucose from food. As a result, all individuals with type 1 diabetes need to take supplemental insulin to control their blood glucose levels.
With type 2 diabetes, the pancreas may still produce insulin, but several situations can occur. The pancreas produces insufficient amounts, or the body resists the insulin or doesn’t make optimal use of it.
Diet, exercise and various oral medications can help the body use its self-produced insulin more efficiently. For this reason, supplemental insulin is less often required to control type 2 diabetes, especially at earlier stages of the disease. In fact, according to the CDC, only 28% of those with type 2 diabetes take insulin.
However, there’s a catch. Type 2 diabetes is a progressive disease, meaning the beta cells deteriorate over time. Eventually, actual insulin therapy -- via injections, insulin pen or insulin pump -- may become necessary.
Type 2 Diabetes and Insulin
A health care professional is probably the best person to help a patient assess whether he or she needs insulin. If a patient’s Hgb A1c (a test that measures average blood glucose over the last few months) is over 8%, there is a good chance he or she would benefit from taking insulin.Some health care professionals think that patients with an A1c over 7% should be on insulin if they are not responding to oral drugs or a new class of drug called GLP-1. If a patient’s Hgb A1c is over 7%, he or she may want to ask a doctor how to reduce it to below 6.5% or 7%, the levels targeted by the American Association of Clinical Endocrinologists and the American Diabetes Association, respectively.
Dr. Richard M. Bergenstahl, executive director of the International Diabetes Center in Minneapolis, thinks that more people with type 2 diabetes should take insulin. Insulin may be the oldest treatment for diabetes, but it remains the most effective for those with high Hgb A1cs that can’t be reduced by other means (oral drugs or GLP-1 based therapies).
Unfortunately, many people with type 2 diabetes avoid taking insulin because they perceive it as some sort of a personal failure. It is not. As time passes, anyone with type 2 diabetes will suffer an increased loss of beta cell function, and at some point insulin will be required. The problem is with the disease, not the patient. If a person needs insulin to maintain normal glucose levels, it should be taken.
Worried about Taking Insulin?
Many people with diabetes worry about taking insulin. They don’t realize that insulin can help improve their diabetes management tremendously and that the drug can make them feel better. In the United States, about 66% of patients with type 2 diabetes aren’t at their glycemic (blood sugar) goals. Speak to a health care provider about trying insulin to reach or maintain these goals.Sources:
"National Diabetes Fact Sheet." National Center for Chronic Disease Prevention and Health Promotion . 09 June 2005. Centers for Disease Control and Prevention. 10 Sep. 2007. <http://www.cdc.gov/diabetes/pubs/factsheet.htm>.
"Type 1 Diabetes." Diabetes.org. American Diabetes Association. 10 Sep. 2007. <http://www.diabetes.org/type-1-diabetes.jsp>.
"Type 2 Diabetes." Diabetes.org. American Diabetes Association. 10 Sep. 2007. <http://www.diabetes.org/type-2-diabetes.jsp>.
"Overcoming Clinical Inertia in Diabetes Care." Physician’s Weekly. 11 June 2007. Physician's Weekly. 10 Sep. 2007. <http://www.physweekly.com/article.asp?issueid=470&articleid=4391>.
Donath, Marc Y., Jan A. Ehses, Kathrin Maedler, Desiree M. Schumann, Helga Ellingsgaard, Elisabeth Eppler, and Manfred Reinecke. "Mechanisms of Beta-Cell Death in Type 2 Diabetes." Diabetes Dec. 2005 S108-S113. 12 Sep. 2007. <http://diabetes.diabetesjournals.org/cgi/reprint/54/suppl_2/S108.pdf>
"Insulin Myths and Facts." Clinical Diabetes. Jan. 2007. American Diabetes Association. 12 Sep. 2007. <http://clinical.diabetesjournals.org/cgi/content/full/25/1/39>
