Oral Agents and "type 1 ½"
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Wednesday, February 22, 2006 |
Q: "I am in between Type 1 and Type 2, am on 5 pills a day (Glucotrol®, Glucophage®, and Actos®), am 28 years old and very underweight. I have only gained back 7 pounds in the past 8 months since I was diagnosed with this. My doctor is trying to keep me off insulin which I appreciate. I am wondering what these 5 pills a day are doing to my body. Would insulin be a better and healthier option? Or does it have as many, or worse, side effects?"
A: If you were well controlled and at your ideal weight (rather than underweight and unable to regain your weight as you now are), you and your doctor would both probably agree these pills were working fine. Many people are managed successfully on combinations of oral agents, such as yours, with no adverse effects. Provided that your doctor has done periodic laboratory tests to make sure your kidney and liver function is fine, I would generally reassure you that diabetes pills are safe and not damaging to the body. For instance, it used to be debated whether or not taking a sulfonlyurea (which is your Glucotrol) stimulates the pancreas so much that the pancreas finally gets exhausted. That theory has now been proven wrong. Instead, it is now known that type 2 diabetes is a progressive disease and, over time, the pancreas is unable to produce enough insulin. Approximately 40-50% of people with type 2 eventually require insulin.
In your case, as you said you are "in between type 1 and type 2"-many diabetes specialists call it "type 1 ½"-which is also described as perhaps a slowly developing type 1 diabetes. In other words, you have not been in ketoacidosis, and you have so far been able to take pills. However, if you are on the maximum dose of the pills, are unable to regain your weight, and are not at your glucose goals, then perhaps it may be time to consider insulin.
Insulin does not have side effects, such as affecting liver function, because insulin is considered a replacement of a hormone of which your own body can't produce enough. Many healthcare professionals have mistakenly given the impression that insulin is "bad" or to be avoided, as they say "I'll try to keep you off insulin." In reality, insulin injections are not painful (finger sticks hurt much more-and hopefully you have been able to test your blood on alternative sites). The negative aspects of insulin would be: the teaching time required to instruct you how to inject (which isn't difficult at all!), and the time it will take to help you determine the proper insulin regimen and the proper dose. You would have to be careful to eat at regular meal times to help you avoid hypoglycemia (low blood sugar) which could occur if you went too long without eating, were more active than usual, or were on the wrong dose of insulin. However, these things aren't difficult to learn, just time consuming. Generally, this is where diabetes educators play a role in assisting doctors with the insulin education. I have assisted many patients over the years in your situation, and once they start insulin, they are always amazed at how good they feel, and how easy it is to take insulin. They then wonder why they waited so long.
I hope this information is helpful, but please discuss this subject further with your doctor.
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
All tradenames and trademarks not owned by Abbott Laboratories are the property of their respective owners. For details on tradenames and trademarks and their respective owners, visit the non-Abbott trademarks listing.
