I have to admit, I love insulin. It is such a cool drug. It has few side effects (potential for hypoglycemia being the biggest concern), it works quickly to bring blood glucose levels under control, and it is relatively easy to deliver with insulin pens and pumps. It has a great track record, beginning with the first dose in 1922. I have studied it’s mechanism of action, role in metabolism, and how to coach dosing for food, exercise and emotional as well as physical stress. I talk to people about it each and every day. It’s of course the only option for folks with type 1 diabetes, but is often put on the back burner for later use with individuals with type 2 diabetes long after (in my opinion) it should have been started. After explaining its power, and the ease of tiny needles and insulin pens, I rarely have a patient who is not willing to try insulin and almost always reports amazement at how effective it is, especially after the frustration of using multiple oral medications for longer than their power lasts.
It was wonderful for me to see basal insulin as a second line of therapy option for patients with an A1C of ≥ 7.5% in the 2013 AACE Comprehensive Diabetes Management Algorithm. Not that it is for everyone, but it is an option! The guidelines also recommend basal insulin plus orals when A1C is ≥ 9.0%.
So it was such an absolute treat for me to read an article in the February 2014 issue of Diabetes Forecast, written by Dan Fleshler, a 51 year veteran of diabetes. The article is titled “Abracadabra: the lessons of insulin.” His description of learning more about insulin, the drug he has used for years, and recognizing the true wonder of the drug is delightful. The term “Abracadabra” reflecting the magic of this drug of drugs, a term Fleshler found to describe insulin as he scoured websites for a better understanding of insulin’s role in the human body. Remember, it was less than 100 years ago, that type 1 diabetes was a death sentence, and now it is “merely” a frustrating, tedious inconvenience.
I hope no diabetes educator is standing in the wings, afraid to recommend insulin to a patient or primary care provider, or perhaps even worse, afraid to work with insulin and the patient. I hope you too are loving the drug, teaching its role in the drug treatment for type 1 diabetes of course, but also a recognizing it as a clear options for individuals with type 2 diabetes. And perhaps you will look at insulin in a bit different light – perhaps using Fleshler’s very delightful and descriptive word “Abracadabra” as you teach patients to inject, just as he does when injecting himself with this life sustaining fluid.