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September 10, 2016

dave

There have always been conversations amongst medical professionals on the best way to get patients to take the diagnosis of type 2 diabetes seriously. Most of these patients have no symptoms and find out by accident when labs are done or they go to a health fair screening. Because the disease may take years to affect a patient’s perception of their health, they often do not do the things that we recommend and are often hard pressed to even listen to any of our recommendations. A couple of years ago during a treatment roundtable, I first floated the idea of putting newly diagnosed patients on insulin from day one.

My reasoning was based on the idea that you could start them on insulin and then offer to move them to oral medications and stop the insulin if they adjusted things like physical activity and food choices for the better. Also this insulin may result in the “resting” of the pancreas to allow it to recover some increased production at a later date. This concept led to some heated conversation, with other educators and prescribers taking sides.

Most of the naysayers felt that trying to scare people with insulin in order to get them to do the right thing had been tried for years, but others pointed out that there was a difference between threatening and actually using. Over those past 2 years, we have tried the insulin-first option in a few patients and the results have been mixed, and there was never really anything out there that looked at the concept in a controlled setting. This week, our first item looks at studies published in 2 peer-reviewed medical journals that support the “insulin-first concept” for not only improving diabetes care, but also for remission of diabetes in certain patients.

Take a look at this great feature and let me know if you have had similar successes with using insulin upon diagnosis.

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We can make a difference!

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Dave Joffe, Editor-in-chief