Type 2 Diabetes: Why Insulin Therapy Is So Difficult to Manage

Insulin dosing is not easy, doctors say.

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This article was originally published at The Conversation. The publication contributed the article to Live Science's Expert Voices: Op-Ed & Insights.

So, your doctor told you that you need insulin therapy for your Type 2 diabetes.

This is a common problem and likely to be more so in the coming years. About 29 million people in the U.S. have Type 2 diabetes, and another 86 million have prediabetes. About one in four people with Type 2 diabetes is on insulin therapy, and another one in four likely needs to be.

What does it mean to be on insulin therapy, exactly? And whose fault is it? Could you have prevented this? Will insulin actually work? These are frequent questions people who need insulin therapy ask, and, as someone who has treated people with diabetes for years and has been working to improve its effectiveness, I will do my best to help you answer these questions. I also have been working to develop a better way to personalize dosing for insulin.

Insulin therapy for Type 2 diabetes

Diabetes is a condition in which your pancreas fails to secrete a sufficient amount of insulin to help you to maintain normal blood glucose, or sugar in the blood, which is transported to various parts of our bodies to supply energy.

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There are many causes of insulin deficiency, but the most common is Type 2 diabetes. The main risk factors for Type 2 diabetes are family history, weight and age.

In fact, most overweight or obese people in the Western world will never develop diabetes. Weight is a very important, yet misunderstood, risk factor for diabetes. The foods you eat are usually less relevant than the weight itself. The American Diabetes Association, for example, recommends that you limit the amount of sugary drinks you drink, including sodas, fruit punches and even sweet tea.

Further, most people in the world with Type 2 diabetes do not fulfill the diagnosis criteria of obesity; rather, their weight exceeds the capacity of their pancreas to maintain sufficient insulin secretion. Your pancreas may have less insulin-secreting capacity than your neighbor's, making you more likely to get diabetes when you gain weight.

Type 2 diabetes is a progressive condition as, over time, the pancreas tends to secrete less and less insulin. In the early stages, when your pancreas can still secrete some level of insulin but not enough to maintain normal blood glucose, losing 5-10 percent of your body weight and more importantly, keeping that weight off, can slow the progression of your insulin deficiency.

Even with weight loss, in the majority of cases, diabetes does eventually progress to the point where you will need to use medications. The majority of diabetes medications (except for insulin replacement therapy) can work only if your pancreas is still able to secrete some insulin.

Due to the progressive nature of the disease, you may require more drugs over time, and at some point, you may become so insulin-deficient that none of them is sufficient for maintaining healthy blood glucose. At that point, insulin replacement therapy is needed.

Keeping glucose levels at the therapy goal is essential

The stage in which you become overtly insulin-deficient typically occurs about 10 years after the diagnosis. There is no evidence to suggest that you can totally prevent this progression. Although keeping a stable weight and being physically active are considered beneficial to overall health, these modalities have very limited impact on advanced stages of diabetes, when your pancreas is secreting little to no insulin.

Having no insulin is damaging and dangerous. Without insulin, your body breaks down necessary fats and proteins that are important parts of your body, causing damage to many organs. The vast majority of diabetes complications occur when patients with advanced diabetes are exposed to elevated blood glucose for a considerable period of time.

If I could give you one piece of advice, it would be to avoid elevated glucose at all cost. If you or a loved one has been diagnosed with diabetes, you are probably familiar with what we call hemoglobin A1c. It is a measure of your average recent glucose levels. Do not let it go up. If you have come to the point that insulin is needed to maintain a healthy glucose level, so be it. It is not your fault that you have arrived at this point; you simply need the correct treatment for the actual stage of your Type 2 diabetes.

So even when insulin therapy is needed at a certain point in the disease's progression, it does not solve patients' health problems. That is because most patients who use insulin therapy do not achieve their treatment goals in maintaining appropriate level of glucose levels in the blood. This is quite surprising, given its benefits and the fact that insulin therapy has existed for almost a century.

Insulin does not have an upper dosage limit, and there is no glucose level that it cannot reduce. Unlike most other drugs, it has only one main adverse effect, namely hypoglycemia, which occurs when glucose levels drop too low. Further, the majority of insulin users are adherent to insulin injections and glucose measurements. Why don't they achieve their treatment goals?

Frequent adjustments of insulin dosage is critical

The problem is not with the patient or the doctor. The problem is the therapy itself. Unlike most other drugs, insulin requirements are very dynamic and need frequent dosage adjustments to overcome constant changes in insulin needs. The range of overall insulin requirements is very wide. No one knows if you need 30 units per day or 300. When your doctor gives you insulin, he or she tries to give you as much as your own pancreas used to secrete before it failed. To know how much insulin you need, your doctor typically starts with a low dose and goes up gradually.

Thus, many adjustments will be required before your doctor knows how much insulin to give you. But it doesn't end there. Your insulin requirements constantly change. Over time, you may need a different dosage. To make insulin therapy effective and safe, you may need a dosage adjustment about every week. Unfortunately, there are so many insulin users that our doctors don't have the time to adjust the dosage this frequently.

Please don't despair; there is technology that can help you to adjust the dosage more frequently. Companies have developed technologies that enable insulin dosage to be as dynamic as needed to make it effective for you.

In summary, it is not your fault that you need insulin therapy. It is just another mode of therapy that you need when your pancreas fails. The main challenge is to adjust your dosage frequently. Fortunately, solutions are becoming available to facilitate this.

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Know if your back pain links to your risk of death

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An aching back is a major cause of disability, and now, a new study finds that people with back pain may also have an increased risk of dying each year.

 People in the study ages 70 and older who reported having back or neck pain in the previous month were 13 percent more likely to die each year from any cause, compared with people who didn't have back pain.

The link between back pain and death, however, is not causal, the researchers noted in the study, which was published Feb. 23 in the European Journal of Pain. In other words, a person's back pain was not the cause of death. [5 Surprising Facts About Pain]

Rather, back pain and neck pain may be signs of other factors linked to an increased risk of death, such as poor health and poor physical abilities, the researchers wrote.  

In the study, researchers from the University of Sydney in Australia analyzed data from the Danish Twin Registry, which includes more than 4,300 twins ages 70 and up living in Denmark. At the beginning of the study, the researchers asked the people if they'd had either back pain or neck pain in the previous month. The follow-up period lasted, on average, about nine years.

People in the study with back or neck pain had a 13 percent higher risk of death from any cause each year compared with those who did not report back or neck pain, the researchers found. However, when the researchers also considered the people's physical abilities and whether they had symptoms of depression, the link between back and neck pain and death was no longer statistically significant, which suggests that spinal pain is not causing people's deaths but rather "is part of a pattern of poor health," the researchers wrote.

Previous research has linked back pain to increased symptoms of anxiety and depression, and reduced social activity, the researchers noted. In addition, the link between pain and decreased physical activity may lead to weight gain, which, in turn, increases a person's risk for a number of diseases, the researchers wrote.

People in the study who were still alive at the end of the study period were more likely to be physically active compared with those who had died, according to the study. 

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Here's How Much Less Sleep Women Get Once They Have Kids

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For moms with kids at home, it’s not in your head: You are getting less sleep than your husband.

A new study finds that less than half of women who have children in the house get enough sleep, while men report that their sleep isn't affected by having kids in the house.

In the study, researcher Kelly Sullivan, an assistant professor of epidemiology at Georgia Southern University, wanted to understand the factors that affect adults' sleep. [5 Surprising Sleep Discoveries]

"It's important to learn what is keeping people from getting the rest they need so we can help them work toward better health," Sullivan said in a statement. "Getting enough sleep is a key component of overall health and can impact the heart, mind and weight," she said.

Sullivan analyzed data on sleep from the 2012 Behavioral Risk Factor Surveillance System, an annual telephone survey conducted across the country. Nearly 3,000 men and 3,000 women were included in the analysis.

The people in the survey reported how much sleep they got, on average, each night. Between seven and nine hours a night was considered an optimum amount of sleep, and less than six hours a night was considered insufficient, according to the study. In addition, the people reported how many days in the previous month they felt unrested.

The researchers compared people's reports of their sleep with a number of factors known to affect sleep, including the number of children in the house, people's exercise levels and whether they also reported snoring.

For women ages 45 and under, the only factor that affected their sleep was having children in the house, Sullivan found. Each kid increased a woman's risk of getting insufficient sleep by 46 percent, she found.

In addition, 48 percent of women in this age group with kids reported getting at least seven hours of sleep a night on average, compared with 62 percent of women of the same age who did not have kids in the house.

For men ages 45 and under, however, kids had no effect on the amount of sleep they got each night, according to the study. Rather, education seemed to make a difference. Men who had less than a high school education were more likely to report insufficient sleep than men who had graduated from college. In addition, men who reported snoring were less likely to get enough sleep, Sullivan found.

Having kids in the house also affected the number of days in the past month that women reported feeling unrested, but kids' presence in the house had no effect on this number among the men, the study found. [7 Strange Facts About Insomnia]

A previous study, published in 2016, found that more women than men reported having difficulty falling asleep and more difficulty staying asleep.

The study abstract was published on Feb. 26 by the American Academy of Neurology. The full findings will be presented at the American Academy of Neurology's annual meeting in Boston in April.

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Be guided by rules, registrar tells lab institutions

•Erhabor

The Acting Registrar/CEO of Medical Laboratory Science Council of Nigeria (MLSCN), Tosan Erhabor, has urged Colleges and Schools of Science and Technology to stick to their areas of jurisdiction at all times.

He made the call while presenting certificates to 10 approved schools and eight others that received full accreditation  in Abuja.

Erhabor told the gathering that the the institutions were approved   after a rigorous process,pledging its support in the training of technicians.

Erhabor said although the council had issued similar certificates in the past without fanfare, it decided to do things differently in tandem with the change mantra of the present administration. He urged them to guard their reputation jealously.

“Your official conduct and the quality of your training will have a far-reaching implication on how the council is perceived as a regulatory body,” he said.

Noting that the institutions are manned by people with high pedigree, Erhabor urged those in charge to bring their wealth of experience to bear on the quality of training available to the students, adding that the institutions were established to reduce the shortage of middle-cadre manpower in the country. This, he said, is line with the government policy to take primary healthcare closer to the people by building at least one functional Primary Health Care (PHC) centre in every ward in the country.

Erhabor said the council would not deter any institution from accomplishing their goals provided such is done within the ambit of the law, but warned: “Your relationship with the Council is that of the regulated and regulator, and the lines must be respected at any given time.”

He said the MLSCN Act 11 of 2003 empowers the Council to ensure that all cadres of competent and well trained medical laboratory personnel are available in every nook and cranny of this country,  “You must, therefore, help to change the narrative of rural areas, as not being fit for purpose, bearing in mind that 70 percent of our citizens live there, and they are part of the citizens we are trained to serve,” he said.

He enjoined the training institutions to continue support for the council to achieve its mandate as he promised that Council would continue to upscale the quality of its services to clients and stakeholders.

Replying on behalf of the training institutions, Mr Seni James Barka representing Gombe State College of Science and Technology, Katungo, Gombe State, expressed appreciation to the Acting Registrar/CEO and his team for giving them the opportunity to contribute their quota to the growth of the medical laboratory services sector, adding that the occasion was the first of its kind. He promised that the training colleges would not let the Council down.

Certificates of approval were presented to 10 Colleges to commence the training of medical laboratory technicians, while eight received certificates for full accreditation.

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