Medicine to Move You

There is one word that strikes fear in the hearts of every
diabetic that I have ever diagnosed in my office.  One word that conjures up images of needles,
syringes, blood, pricking yourself day in and day out, chasing high blood
sugars and low blood sugars to avoid the dismal future of uncontrolled
diabetes.  This word, as you already have
guessed, ‘insulin’ is one we avoid in practice, because patients liken it to be
given a terminal disease- as though we have told them, “There is nothing else
we can do for you at this point in your disease, so we regret to inform you that
you must start insulin to save your life.” 

Currently, physicians have big organizations that advise
them on when it would be best to start insulin therapy for Type 2
diabetics.  Type 2’s used to be called ‘adult
onset diabetics,’ but that was when 50 year olds used to be the bulk of the
newly diagnosed.  Now, with more and more
teenagers being diagnosed with Type 2 diabetes, we can no longer use the words ‘adult
onset.’  Based on some guidelines, if you
were diagnosed before the age of 30 or if you have had diabetes for over 15
years, you should have been considered for insulin?  My bet: most of the people you know who meet
these criteria are likely not on insulin. 
Why?  Well, physicians are humans
too.  They don’t want to start you on
insulin just as much as you don’t want to take it!  Ok, maybe patients win on this tug-o-war in
real life, but you get the point.  Here’s
an interesting excerpt from Diabetes Health magazine:

“The overwhelming majority of type 2s eventually require insulin
to obtain or preserve satisfactory glucose control and an A1c of 7% or less
[see below explanation of A1c].
Research clearly shows that achieving good control early on prevents diabetic
complications, including nerve, kidney, eye and heart disease, up to twenty
years later.

Deciding exactly when to begin insulin therapy is problematic for
physicians who treat type 2 diabetes. Patients’ misguided fears about needles, hypoglycemia,
and weight gain often lead to reluctance and physician inertia. A recent survey
found that fewer than half of all physicians made any change in diabetes
therapy even for patients with A1c’s of over 9%.

A similar study at Johns Hopkins found that it took an average of
240 days before doctors added insulin or another drug for patients who could
not achieve good control. By the time they finally took action, two-thirds of
their patients had A1c levels approaching 10%.”

How depressing is this for diabetic readers!  Luckily, Integrative Medicine does not take
insulin sitting down- literally!  It is
well known that 95% of Type 2 diabetes is caused by poor lifestyle.  That is to say, that 95% of why teens and
adults with Type 2 diabetes get the disease is because they choose unhealthy
ways of moving (or lack thereof), unhealthy ways of eating, and unhealthy ways
of managing stress.  Changing lifestyle
is just as powerful as any drug, even as powerful as insulin and we see this
every day in our office.

Just this last week, my physician assistant Karen, was jubilated
after seeing the latest blood work of a patient with whom she had been treating with therapeutic lifestyle
change.  This 40+ year old woman came in
with vague complaints and was found to have horribly controlled diabetes
through her initial labs.  Her HgbA1c was
10.9.  By the way, HgbA1c is a 3 month test score of how your blood sugars are running
and the goal for diabetics is less than 6.5%. 
Based on her A1c, we should have started her on insulin per guidelines.  However, she accepted that her lifestyle was
less than optimal and she agreed to make radical changes in order to avoid
insulin.  Now, let’s just stop here and
talk about something.  Whenever someone
gets in trouble or faces a dreadful prospect, there is some sincere bargaining
that soon starts.  When this patient
agreed to change her ways, we were happy but not blissfully ignorant.  We were on her like ‘white-on-rice’ to be sure
her promises were not hollow.  We
initiated a rigorous detoxification program followed by a strict low glycemic
index, anti-inflammatory diet to help treat the underlying cause of her
diabetes… POOR LIFESTYLE!!!  We followed
her blood sugars closely until she was in a safer place.  Her latest A1c was under 7, using just one oral
diabetic medication plus a whole lot of healthy living.  Let me put this into perspective- if she
would have been diagnosed and managed by the standard medical approach as it is
practiced today, she would have been placed on 2, if not 3, medications easily
and still might not have avoided injecting insulin at the end of the
story.  Back in our world, she is loses weight,
feels better, has less aches and pains and her associated fatty liver disease
is on the mend. That is therapeutic
lifestyle change in all its glory!

Insulin is a powerful and necessary drug for many patients;
however, it is avoidable for many Type 2 diabetics if they are willing to
change their lifestyle.  Until the
medical community puts the appropriate emphasis on really teaching patients how
to avoid or treat diabetes with proper lifestyle, we will continue to need more
and more medications like insulin in our medicine cabinet.  My opinion: 
The current 2 day diabetic diet education courses that are available are
well-meaning but lack the power to change a patient’s lifestyle for any
significant length of time.  It’s like
going to church for 2 days and thinking you’ve got God figured out!  Good lifestyle is a daily practice of
discipline requiring guidance by experienced lifestyle medicine providers.  An easy measuring stick for anyone giving you
lifestyle advice…are they practicing what they preach and working to live their
healthiest life?  If not, move on and be
inspired by someone who does. 


This information is intended for informational and
entertainment purposes only and is not a substitute for medical advice,
diagnosis or treatment.  Please consult
your physician.

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