On Friday morning after I got done with a 40 mile bike ride with our local club, we were sitting and talking at our favorite coffee shop when my phone rang. It was a family friend who wanted to talk about her husband’s medications for diabetes. He had been referred to an endocrinologist who wanted to start him on insulin, and they wanted to try anything to avoid that. I only needed to ask two questions; "Is his A1c high?" and "Has he lost a lot of weight without trying?"
The answer to both questions was "Yes," a perfect indication that he needed to be on insulin. I explained this to him and his wife, and they asked me why their regular doctor had not told them that. I tried to explain how primary care physicians often postpone starting insulin and after looking at some information from the American Association of Clinical Endocrinologists, I can see why. A recent survey indicated that two-thirds of primary care physicians surveyed said they delayed initiation of insulin therapy for type 2 patients because patients they would think it was too much of a burden. Funny thing is when I explained how insulin worked and made a comparison to being vitamin D deficient, the patient and his wife immediately understood why the endocrinologist made the recommendation.
Starting insulin may get easier when basal insulin peglispro (BIL) gets approved. If you have never heard of it, then be sure to read Item #1 and find out why.
Dave Joffe, Editor-in-chief