Monday, November 28, 2011

Insulin. Get Over It.

Today’s Prompt: Say WHAT?! What’s the most ridiculous thing you’ve heard about health or your condition. Was there any context? What did you think at the time you heard it – and what do you think of it now?

De-mythologizing is a big part of being a health activist.

I can't pinpoint the craziest thing I've heard people say about diabetes. Probably because I hear something new every week.

Like others have said today, cure talk pisses me off - whether it's people telling you about a diet, a lifestyle, or a book, there is no cure. There is no REVERSAL.

Halle Berry, Drew Carey, and your stepson's grandma were not type 1s who transitioned to type 2s when they "weaned" themselves off of insulin. They are two separate diseases. It's not like becoming a blonde because you found the right stylist. It'd be like saying you weaned yourself off of oxygen. If you're a type 1, you have to take insulin because your body doesn't produce it. And it blows. There's no regeneration of your islet cells. That's bullshit.

But I want to give the ridiculous award to just about every journalist or media personality who has covered diabetes.

I was listening to NPR yesterday and heard a human interest story about a man who fights type 2 diabetes by going back to his ethnic dietary roots. It was an interesting piece and I enjoyed hearing about the impromptu cooking demos/shows the guy apparently gives on street corners...until they mentioned the diabetes bit. His father, the reporter told us, "refused" insulin and managed his condition with diet alone.


Yeah, like I said, go back and change the word "insulin" to "oxygen." WTF?

People just don't understand the hormone and what it does. You - yes, you reading this right now - YOU are benefitting from insulin right this very second. It's keeping your last meal in check, keeping your blood sugar stable, keeping you from the corrosive effects of high blood sugar on your blood vessels and nerve endings. It's keeping you ALIVE. And without it, you would DIE. If your body doesn't produce the amount you need, you become very ill. And if your body stops producing it, your blood would become highly acidic and boil your organs as you slipped into a coma and DIED. Your body makes the precise amount you need every moment and delivers it like a perfectly oiled machine. (Yes, I'm jealous.)

Many Type 2 diabetics "fight" to stay off of it. As though it were a choice like the way you'd push through pain in order to resist narcotics. It's a progressive condition and many, dare I say most, people with Type 2 will eventually need at least a basal, if not also a mealtime, insulin regimen. And ALL people with Type 1 will need both. ALL.

And yet it's treated by those who don't understand it as though it's somewhere on the spectrum of "drug for the lazy fat guy who wouldn't stick to his diet" and "cure for the little girl on the poster."

It's neither.

It's $100 a bottle (I use 2 bottles a month), they don't sell a generic (yeah, seriously), it's imprecise and unpredictable as hell, and there are 2 different ways to take it (shots or pumps - no, the inhaled stuff you heard about got taken off the market and was never very effective and wasn't for people with type 1 anyway).

What is it? Why do I need it? What does it do?
6 molecules of Insulin arranged in a hexamer. Thank you, Wikipedia.
Your pancreas makes it in these tiny little cell clumps called the Islets of Langerhans. You have about a million of these little islets. The beta cells in these clusters are what produce insulin.

The best analogy for how insulin works in the body is to think of insulin like a key. Your cells, which need glucose for energy, have a locked door and hungry kids inside. When you eat, food converts to glucose and hangs around outside these cells like a lost pizza delivery guy. You really need that key. Otherwise, glucose builds up in your blood stream and causes that whole nasty coma business.

In a person with Type 1 Diabetes, the immune system targets beta cells and destroys them. You could transplant new ones in, but your immune system would eventually go after them again and you'd need immunosuppression to the nth degree. Yeah, I know, it blows. In an autoimmune disease, your immune system is the schoolyard bully and whatever poor bastard of an organ or system it has targeted is the wheezy kid with spectacles. Type 1 can strike at any age - and 85% of those living with it today are adults. There is no cure, we all take insulin, and we eat sugar. As a matter of fact, when our blood sugar drops too low, we have to eat sugar or we could die.

In a person with Type 2 Diabetes, the body begins to have problems using insulin effectively. The beta cells kick into overdrive and often overproduce insulin until the cells can no longer function. That's when you have to begin taking insulin exogenously. Lifestyle factors, genetic predisposition, other medical conditions...many of these may affect the progression of the disease or delay or speed up its onset. Obesity may be an early symptom of type 2, and not necessarily the cause. There are thin, athletic people with Type 2, just as there are people with poor diet or too much weight.

There are other forms of diabetes. Monogenic, gestational, etc. These have their own idiosyncrasies.

What they all have in common is the tricky balance between insulin production/performance and blood sugar management.

What they all have in common is the concern about developing complications from not being able to balance what the body ought to have been able to do on its own.

What WE all have in common is insulin. Stop demonizing it!

This post was written as part of NHBPM - 30 health posts in 30 days:


  1. The concept I like best in diabetes advocacy is that ALL diabetics have a problem with not enough insulin. Even hyperinsulinemic (as compared with "normal") Type 2 diabetics can't secrete enough insulin for THEIR needs. And we ALL have a problem with regulating our blood sugars. And it's never easy, and it's not our fault. If there was one message I could get through to the media and the public, that would be it. :-)

  2. I remember in the beginning of my dianosis with T1 about 10 months ago, I thought of insulin as a drug, and wanted to take as little as possible. Though my oldest daughter reminded me "mom, this is something your body once produced, you are just replacing it". Made me look at it in a different light.

  3. Loved this post! I really giggled at the "lost pizza delivery guy" comment and had to read it aloud to my co-worker *grin*

  4. "It's not like becoming a blonde because you found the right stylist." HA! Love this part!