Saturday, May 19, 2012

. My doctor says that I need to start insulin. If I do, will I ever get off it?

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.

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