Overcoming barriers to insulin therapy is vital for keeping diabetes under control.
DIABETES is a lifelong disease that we frequently hear or read about in the media, and talk about among our peers. With 2.6 million registered patients in Malaysia, it is one of the leading disorders in the country.
The National Health and Morbidity Survey (NHMS) revealed that the percentage of Malaysian adults over 30 years old with diabetes has risen drastically, from about 6% to 20% over the span of the last two and a half decades.
What’s more alarming is that diabetes is seen as no longer a disease of the middle or old age. Children as young as 10 years old are suffering from diabetes, and this points to the link of either maternal/paternal imprinting or high rates of obesity among children and adolescents.
For type 1 diabetes, which is an auto-immune disease, insulin is inevitable. However, for patients with type 2 diabetes, in most cases, it is a matter of time before insulin shots replace or have to be combined with oral medication.
The pancreas, an organ located in our abdomen, plays an essential role in converting the food we eat into energy. This important organ also secretes a hormone called insulin, which acts to lower our blood sugar. We need insulin to help our body maintain normal blood sugar levels that are crucial to the functioning of the key organs in the body, including the brain, liver and kidneys.
“In a patient with pre-diabetes, the beta function of the pancreatic cells will slowly deteriorate and insulin secretion will gradually decrease, thus it is important for these patients to act on the disease before they develop diabetes,” said consultant endocrinologist Dr Wong Ming.
Unfortunately, there seems to be a negative connotation connected to all things relating to syringe or needles, especially when it involves injecting oneself. With little education and awareness on insulin needles, diabetics tend to feel embarrassed about this and is worried of being associated as a drug addict if the need to give themselves a shot in public arises.
It can be difficult for a patient to accept the fact that they need to be on insulin treatment for the rest of their lives. “Some patients feel like it’s the end of the road once they start insulin as they find it hard to accept that they have to inject themselves every day for the rest of their life,” said Dr Wong.
When it comes to a lifetime of medications, patients will certainly have many concerns. First, there is the cost factor. Depending on the type and frequency of insulin a patient needs, the cost can vary, from as little as RM30 a month to as high as RM200. This does not include other equipment or tools a patient needs for regular blood glucose monitoring.
Another common worry is fear of needles. However, the fact is the needle from the insulin suspension is very fine and short. “Some patients just can’t give themselves a shot, but are completely fine with another person injecting them. We will then need to spend time to educate caregivers in proper administration of insulin,” said diabetes nurse specialist Wong Su Fei.
For most patients, once they understand and accept the fact that the pancreas ages faster than the rest of the organs and that is the reason for them to be on insulin, they tend to sail through this journey without much problems.
“Once I found out that I needed to be on insulin shots, I couldn’t help but feel scared as I would have to inject myself every single day. But with the constant support and help from various sources, I realised that it is not so difficult after all. It’s not even that painful,” said Mary Louise, 63, a diabetes patient.
Mary has been living with diabetes since she was 28 years old. She discovered she had diabetes after going for a medical check-up.
For newly diagnosed type II diabetes patients, oral medication is usually the standard treatment until the patient develops insulin deficiency or insulin resistance.
“The majority of patients will require insulin six to 10 years after the disease is diagnosed as the beta cells of the pancreas fail to secrete sufficient insulin to control the blood sugar. This is the natural history of progression of type 2 diabetes,” added Dr Wong.
In other words, most type II diabetes patients will have no choice but to switch from oral medication to insulin shots or a combination of both in order to maintain proper level of their blood glucose.
But before this happens, some form of lifestyle modification can help to delay insulin treatment. With adequate exercise, maintenance of a healthy BMI and diet containing a balanced choice of food items in recommended portions, a diabetes patient can continue with the necessary oral medication and possibly delay starting on insulin treatment.
Some patients are fortunate to be able to delay insulin therapy for much longer than 10 years. “I only started insulin injections 30 years after I was diagnosed with diabetes. I was only on oral tablets all this while, until a year ago,” said Mary.
“I believe that my positive mindset combined with a balanced diet and frequent exercise help in my delaying of starting insulin injections. I also think that it is important to take your medications diligently, as per the doctor’s advice,” added Mary.
Mary shared with us that she still gets to consume her favourite food, but with proper control. “If I eat ice cream in the morning, I will cut down on my dinner. This way, I get to eat all the food I enjoy, such as durian and desserts,” said Mary.
The delivery of insulin therapy has seen many developments over the years since the first mass production of insulin in the 1920s. Some of the advancements are the replacement of syringes with “pens” and reduction in the frequency of injections due to mixture of therapy. Patients used to have to wait 30 to 45 minutes before or after an insulin injection in order to consume food. This is not required with modern treatments.
Dr Wong added: “Clinical trials are being conducted in order to make it even easier for patients. We may reach a day when diabetes patients only need to inject insulin every other day, instead of every day.
“Diabetes treatment is not a one-size-fits-all matter. There are different regimes and treatments to fit different lifestyles. So, we often ask patients to take it one step at a time. Lifestyle modification, which includes diet and exercise, remains the cornerstone in the management of diabetic patients.”
This article is courtesy of Sunway Medical Centre.