Happy Saturday! Welcome back to Request D’Mine, our weekly advice column hosted by veteran type 1, diabetes author and clinical instructor Wil Dubois.
This week, Wil dives to a question about the top “non-insulin” choices for those in the type 2 world. Continue reading, for Wil’s unbridled opinion (as usual)…
Achat, type 3 in India, writes:Kindly advise me if there’s another option to insulin. My daddy was diagnosed with type 2 diabetes four to five years back and since then he’s treated with regular insulin. I would like to know if there is substitute medication to take instead to insulin. Thank you.
Wil@Ask D’Mine replies: You gamble. All types of substitutes. There are tons of tablets for type 2 diabetes. There are tablets that enable the pancreas to produce more insulin. There are tablets that keep the liver from releasing too much of its sugar. There are tablets that combat the insulin resistance that’s the basis of type 2 diabetes. There are pills which make you pee the glucose from your own blood. There are tablets that combat the digestive hormones which are running amok in the gut. There are tablets that keep you away from digesting carbs. There are tablets that reduce digestive juices to reduce blood glucose. There are tablets that mess around with the central nervous system to reduce glucose production within the body. There are so many pills that I’ve probably left a few of these outside. The majority of these tablets are made by several different makers, and there are even many combo tablets which have more than one of those medications in them.
Plenty of substitutes. Plenty of choices.
But all of this said, why do you want an alternative to insulin to your daddy? Surely his physician needs to have considered all of those many piles of tablets before (s)he prescribed the insulin. There should have been some fantastic reason to select insulin. So my question to you is: Why is your daddy unhappy with taking insulin, or are you the miserable one? The main reason why I ask is that I have discovered that it is generally the men and women who don’t really utilize insulin who have the biggest difficulties with it, while people who take insulin are usually pretty happy with it.
So let’s talk about that.
One of non-insulin-using insulin-haters, I have discovered that individuals usually have two issues with insulin: The first is that insulin is misunderstood. And the next is that insulin requires an injection. You know. Using a needle. (Although they’re focusing on both insulin tablets and oral insulin movies as I write this.) Let’s debunk some needle myths initially, and then I’ll take on insulin lousy rep.
On the outside, I’ll give you that shooting shots seems frightening. Nobody enjoys shots. But insulin shots are different from other types of shots. As somebody who’s shot literally tens of thousands of insulin shots, then you will need to trust me on this: It’s no big deal. And it is not just that I got used to them. The simple fact is that insulin shots have very little in common with different forms of shots.
The majority of the dreadful shots individuals get are vaccines — things like immunizations, flu shots, tetanus shots, and so on. These vaccines utilize pretty large, long needles. In reality, adult vaccines commonly utilize a 19-gauge three-inch-long needle. You can harpoon a Salmon with one of those things. Plus the shots are frequently what we call intramuscular injections, so the needle, which we have already established is big, goes deeeeeeep in your body. Throughout the skin, through the fat, then down deeply to the muscle, nearly to the bone.
Muscles are pretty rich in nerve endings, so poking things in these causes a pain reaction. Ouch! Next, the fluid quantity of most vaccines is on the large side. A good deal of liquid has been forced into the cells, and cells don’t enjoy this. Ow, ow, ow! Plus, a few shot-givers are more skilled than others. Hint: Never get a shot from a Physician. Always decide on a nurse rather, and if you’ve got a choice don’t pick the youthful, pretty one. Decide on the old crabby-looking one! If it comes to painless shots, there’s no substitute for experience.
Anyway, all of these factors add up to one thing: Shots are often a painful experience. It can hurt getting poked, and the vaccine website can ache for hours (or days) later. The majority of us avoid pain at almost all costs. After all, with all due regard to the Fifty Shades of Grey Fan Club, even in the event that you truly love pain, then there’s likely something wrong with your mind.
I understand why you may worry about your daddy taking shots all the time. But have you asked him about it? Because here’s the deal: The only thing an insulin taken has in common with a vaccine taken is your syringe. Well, the vague look of this syringe, anyway. Not all syringes are made equal, and insulin syringes would be the Brazilian Super Models of this syringe world. They’re ultra-skinny and also hold a ridiculously small amount of fluid in comparison to some other types of syringes. Bear in mind that three-inch needle? Most modern insulin syringes utilize needles which are only a quarter-of-an-inch long, and at 31 gauge, the width of the needle is similar to a human eyelash. You would be hard pressed to harpoon a Minnow with those babies.
The shot doesn’t go deep into the body at all. It reaches muscle, rather going to the fat layer just beneath the epidermis. Fat doesn’t have much in the means of nerve endings. And the fluid quantity of most insulin shots is little in comparison to most vaccines, so the pool of insulin isn’t pushing much tissue from the way.
All of that adds up to the fact that insulin shots actually are not as bad as most men and women think. In reality, they’re virtually painless. Nearly 100 percent of those several hundred individuals I have started on insulin have said the exact same thing (once they summon the guts to take the first shot): “I did not feel it at all! The frickin’ fingersticks hurt worse!”
But don’t take my word for it.
Try it for yourself. On yourself. Take one of the unused syringes of your daddy and give yourself a poke. You are going to be surprised. Obviously, use a vacant one, then dispose of it later.
OK. So that is one issue. Some shots do hurt. Damn straight. But insulin shots normally don’t.
On to insulin lousy rep. Seriously, insulin needs to fire its PR firm. I doubt there’s ever been a more unjustly maligned substance in human history. It’s amazing to me just how much a life-saving, effective, simple, reliable medication that performs well with other medications and contains virtually no nasty side effects, can be loathed and reviled.
Hell, Hitler had a better reputation.
You wouldn’t think. It will make you go blind. It’ll make your own kidneys fail. It causes amputations. That insulin will kill you!
If insulin were a celebrity, it could be wealthy beyond belief from libel suit settlements.
Not one of those things are accurate. Consider that everyone alive on Earth is “on” insulin. It is a naturally-occurring chemical in all of our bodies. On your daddy’s case, he either doesn’t make quite enough of his own his own body doesn’t use it very efficiently, so he has to take some additional to keep his glucose in control.
Yes, for type 2s, there are many substitutes for insulin. Pills which can be taken. But they’re all workarounds. They’re complicated backdoor maneuvers designed to compensate for the shortage of insulin in a type 2’s body, without having to take the obvious measure of simply supplementing what’s missing. If you are short on insulin, then simply add insulin. If you car doesn’t have enough gas to get where you want to go, what makes more sense — filling up the tank with gasoline, or greasing the tires to make it roll better if it runs out?
And, to be honest, diabetes pills frighten me a little, and as time goes by I get a little more fearful of these every day. Insulin is simple, understood, and hasn’t had to be remembered, banned, or black-boxed–all things which have occurred with diabetes tablets. Plus, some of these diabetes pills carry long lists of contra-indicated medications. In short, they don’t play well in the sand box along with different meds, while insulin plays well with other drugs.
So in my book, although there are pills which can be substituted for insulin, then there’s really just no substitute for insulin.
This isn’t a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a little portion of your whole prescription. You still need the expert guidance, treatment, and maintenance of a licensed medical practitioner.
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