- With Mayo Clinic diabetes educators
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.read biographyclose window
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.Nancy Klobassa Davidson and Peggy Moreland
Nancy Klobassa Davidson, R.N., B.S.N, C.D.E
Nancy Klobassa Davidson is a registered nurse who has worked in diabetes education for 17 years. She is a certified diabetes educator (C.D.E.) and is currently in graduate school working on a Master of Science in nursing (M.S.N.) and health care education.
Nancy works with adults who have type 1, type 2 and other forms of diabetes. Nancy is coordinator of the Diabetes Unit's intensive insulin therapy program within the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn. Nancy has worked extensively with insulin pump therapy and continuous interstitial glucose sensing.
Peggy Moreland, R.N., M.S.N.
Peggy Moreland is a certified diabetes educator (C.D.E.) in the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn.
Peggy graduated with a Master of Science in Nursing and Health Care Education from the University of Phoenix and is a member of the American Association of Diabetes Educators and the American Diabetes Association. A certified diabetes educator (C.D.E.), Peggy enjoys working with patients to set and achieve diabetes self-management goals.
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Type 2 diabetes treatments: Why oral meds first?
By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
One of our readers asked "Why is insulin only considered after oral medications have been found ineffective?" I think this is an excellent question. However, I'm not sure that I have a good answer.
An October 2008 study in Diabetes Care concluded that a six-month course of insulin therapy, compared with oral anti-diabetes drugs (OADs), could more effectively result in adequate glycemic control and improvement of pancreatic insulin producing cells in those who had new-onset type 2 diabetes with severe high blood sugar levels.
Type 2 diabetes is progressive, and the insulin producing cells in the pancreas deteriorate over time. There are an increasing number of children, teens, and young adults who are diagnosed with type 2 diabetes. They'll live longer with diabetes than others before them, and so will be more likely to develop severe insulin-deficiency that requires insulin replacement earlier in life.
Reasons why insulin might not be prescribed sooner if you have type 2 diabetes may include:
- Doctors are concerned about you getting low blood sugar.
- You might not be willing to start insulin or might not have the ability to give yourself injections.
- Primary care providers may perceive that insulin therapy is too complex to manage in their busy practice.
- Prescribing information may be vague, and the provider may be unsure about initial dosing, titration and what kind of insulin to start you on, which may delay making the necessary transition from oral medications to insulin.
According to an April 2005 article in Clinical Diabetes, an A1C level of 9 percent or more signifies the need to take action to lower blood glucose. Numerous studies have shown that early intervention with insulin is more important than was previously believed.
So, I don't have a good answer to this reader's question. However, if your oral medication(s) are no longer helping you control your blood sugar, discuss the option of insulin as a next step with your provider. Taking insulin doesn't mean that you've failed to manage your blood sugar. Type 2 diabetes is a progressive disease, and if you have it long enough, chances are you may eventually need insulin.
Have a good week,