People with type 1 diabetes
usually cannot discontinue
insulin use once they have started. This is because of the
very severe deficiency of insulin
in this disorder. However, there are a couple of exceptions to this gen- eral rule. First, there is often a brief period
of improvement
in
pancreas function after
the
initial
diagnosis of type 1 diabetes. This so-called
“honey- moon period” can last for a few weeks to a couple of
years. During this time, the amount of insulin
needed to control the
blood glucose is much lower and the occasional patient
needs none at all. Second, people who have received
either a pancreas transplant or a
pancreatic islet cell transplant
can sometimes stop using insulin.
The latter
procedure is still considered an experimental therapy. Although
they can reduce or eliminate the need for insulin injections, these proce- dures should not be undertaken lightly, because they are associated with a lifelong need for powerful
immunosuppressive (antirejection) drugs that
can cause serious side effects.
In principle, it is possible
for a person with type 2 dia- betes to discontinue insulin once he or she has started it, if the lifestyle factors that led to the worsening of the diabetes can
be
reversed.
Since the overwhelming majority of cases of type 2 diabetes
are associated with overweight and lack of exercise, weight reduction and commencement of a regular exercise
program
will almost always result in significant improvement in
glu- cose control and can lead a person on insulin being able to discontinue it. Unfortunately, in our society, it is very difficult for most people with type 2 diabetes
to consistently pursue these goals
and the majority will remain on insulin once it has been started. Also, it is
a normal part of aging for the insulin-secreting cells of
the pancreas (beta cells) to show declining function.
The rate of this decline may be faster in people with type 2 diabetes. This leads to a need to intensify
treat- ment over time and may explain in part
why the majority of those who start insulin treatment will not be able to discontinue it without significant deteriora- tion in control of their diabetes.
No comments:
Post a Comment