Insulin Use in Diabetes: Risks, Concerns, and Alternatives

Q: Insulin Use in Diabetes: Risks, Concerns, and Alternatives

Miss Huang： I apologize for the delayed response due to a computer malfunction. Your questions are very professional. 1. There are many causes of diarrhea, and certain oral antidiabetic medications can indeed cause diarrhea (such as Glucobay and Glucophage). Y

What are the potential issues that diabetic patients may encounter when administering insulin?

Hello Dr.
Shi, my mother (63 years old) has been suffering from diabetes for nearly 30 years (family history).
She has been controlling her blood sugar with oral medications, but since the end of last year, an increase in medication dosage has caused diarrhea.
The doctor recommended switching to insulin injections, which she has now started.
I would like to ask: (1) What are the potential long-term complications of insulin therapy? (2) What issues should we be aware of? (3) Are there other methods that can be used alongside insulin injections to more effectively improve/control blood sugar? Thank you for taking the time to respond.

Ms. Huang, 30~39 year old female. Ask Date: 2005/01/18

Dr. Shi Guangzhong reply Internal Medicine

Miss Huang: I apologize for the delayed response due to a computer malfunction.
Your questions are very professional.

1.
There are many causes of diarrhea, and certain oral antidiabetic medications can indeed cause diarrhea (such as Glucobay and Glucophage).
You should consult your physician to determine whether the diarrhea is truly caused by the medication or other factors.
2.
One disadvantage of long-term insulin use is the development of insulin antibodies.
Compared to insulin, insulin antibodies are large proteins that can bind to insulin, reducing its blood glucose-lowering effect.
Therefore, patients who have been on insulin for an extended period may feel that it is becoming less effective and may need to increase their insulin dosage.
During situations such as fever or acidosis, insulin antibodies and insulin may separate, leading to a significant amount of free insulin in the body.
This can result in severe hypoglycemia, which in severe cases can cause brain hypoxia or even death.
Additionally, long-term insulin injections can lead to localized skin reactions such as redness, itching, allergies, and lower limb edema.
3.
Certainly, there are factors such as dietary control, moderate exercise, newer generations of oral antidiabetic medications, patient adherence to medical advice, regular self-monitoring of blood glucose, the motivation of the patient and their family, and the management of diabetes-related complications like hypertension and hyperlipidemia.
Increasing knowledge about diabetes and ensuring that the physician has adequate expertise can also contribute to more effective blood glucose control.
I believe your mother is managing her condition very well, especially since she has been living with diabetes for nearly thirty years and has only recently switched to insulin injections for blood glucose control, which is commendable.

Reply Date: 2005/01/18

More Info

Hello! Thank you for your questions regarding insulin use in diabetes management. It's great that you're seeking to understand more about this important topic, especially considering your mother's long history with diabetes. Let's break down your questions one by one.

1. Long-term Effects of Insulin Use
While insulin is a vital treatment for many individuals with diabetes, especially those with Type 1 diabetes or advanced Type 2 diabetes, there are potential long-term effects and complications associated with its use. Some of these include:
- Weight Gain: Insulin therapy can lead to weight gain, which is a common concern for many patients. This is often due to the fact that insulin promotes the storage of glucose as fat, and patients may also experience an increase in appetite.

- Hypoglycemia: One of the most significant risks of insulin therapy is hypoglycemia, or low blood sugar. This can occur if the insulin dose is too high relative to food intake or physical activity. Symptoms can range from mild (shakiness, sweating) to severe (confusion, loss of consciousness).

- Insulin Resistance: Over time, some patients may develop insulin resistance, which means that their body requires more insulin to achieve the same blood sugar-lowering effect. This can lead to higher doses of insulin being needed.

- Injection Site Issues: Repeated injections can lead to lipodystrophy, which is a change in fat distribution at the injection sites. This can cause lumps or indentations in the skin, which may affect insulin absorption.

2. Important Considerations
When using insulin, there are several important factors to keep in mind:
- Monitoring Blood Sugar Levels: Regular monitoring of blood glucose levels is crucial to ensure that insulin doses are appropriate and to prevent hypoglycemia.

- Diet and Exercise: Maintaining a balanced diet and regular physical activity can help improve insulin sensitivity and overall blood sugar control. It’s essential to coordinate meals and snacks with insulin administration.

- Education on Hypoglycemia: Understanding the signs and symptoms of low blood sugar is vital. Patients should always carry a source of fast-acting glucose (like glucose tablets or juice) to treat hypoglycemia if it occurs.

- Regular Follow-ups: Regular check-ups with healthcare providers are necessary to adjust insulin doses and monitor for any complications related to diabetes or insulin therapy.

3. Alternative Methods for Blood Sugar Control
In addition to insulin therapy, there are several other strategies that can help improve blood sugar control:
- Oral Medications: Depending on your mother's specific situation, her healthcare provider may consider adding or switching to other oral diabetes medications that can work alongside insulin. These include medications like Metformin, GLP-1 receptor agonists, or SGLT2 inhibitors, which can help improve blood sugar control and may also aid in weight management.

- Continuous Glucose Monitoring (CGM): This technology allows for real-time monitoring of blood sugar levels, which can help patients make more informed decisions about their insulin dosing and lifestyle choices.

- Dietary Changes: A registered dietitian can help develop a personalized meal plan that focuses on low glycemic index foods, balanced macronutrients, and portion control to help manage blood sugar levels.

- Physical Activity: Regular exercise can improve insulin sensitivity and help control blood sugar levels. It’s important to find activities that your mother enjoys and can incorporate into her daily routine.

- Education and Support: Diabetes education programs can provide valuable information and support for both patients and their families, helping them to manage diabetes more effectively.

In conclusion, while insulin is a critical component of diabetes management, it is essential to consider the potential risks and to adopt a comprehensive approach that includes lifestyle modifications, regular monitoring, and possibly additional medications. Always consult with healthcare professionals to tailor the treatment plan to your mother’s specific needs. Thank you for your thoughtful questions, and I wish you and your mother the best in managing her diabetes!

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