Syringes, Pens, and Pumps, Oh My!
I think everyone knows what a syringe is: It's a tube designed to hold a liquid, a plunger to draw the liquid into the tube and push it out again, and a needle to break the human skin to get the liquid where it needs to go. Once upon a time, only a few decades ago, syringes were glass and metal affairs that had to be boiled between uses, and needles were giant stainless steel harpoons that had to be sharpened on whetstones like knives. Now we have disposable plastic one-shot syringes with high-tech needles the size of a human eyelash. Syringes are the traditional way to deliver insulin, and are still commonly in use in the USA today.
In some parts of this country, and in most of the rest of the civilized world, the syringe has been replaced by the pen. An insulin pen is a fountain pen-sized multi-shot device with a tiny screw cap needle on one end and a dial to set a dose on the other end. They come in both pre-filled disposable varieties, and in sturdy metal beauties that can be refilled.
Lastly, an insulin pump is an alternative way to get insulin into the body. It's a high-tech computerized device that automates some, but not all, of insulin delivery. Instead of one big shot, pumps continuously infuse small amounts of insulin into your body all of the time.
A Good Girl with a Bad Reputation
Now in all fairness, insulin cannot be said to be either feminine nor masculine, but it's certainly one of the most misunderstood medications of all time. I say that because many people are terrified of going "on" insulin. Is it just the needle? After all, sticking yourself with a needle is arguably an unnatural (but nowadays painless) act.
No, fear of needles isn't the whole story. Because if we look at other injectable diabetes medications like Byetta and Victoza, there's very little resistance from dFolk to taking these meds, which also require needles. So does the lure of weight loss overcome the fear of needles, or is there something else going on?
How did insulin get such a bum rep?
The answer: Stupid doctors. For decades many docs tried to control their patients' behavior by using fear. They'd hold up the vial and syringe like a baseball bat: "You'd better do what I tell you or I'll have to put you on the needle."
(A rather short-sighted motivational technique given that the natural history of diabetes shows us nearly everyone with diabetes will end up on insulin at some point.)
Thus, used as a threat, insulin became the de facto medication of last resort. Often the elixir of life was delayed too long. Historically, by the time many type 2s were started on insulin, complications had already set in. Families remembered that grandma was put on insulin and then went blind. Families remembered that grandpa was put on insulin and then his feet were cut off. Avoid insulin: that stuff will kill you!
It was the combination of these three factors that ended up giving insulin a bad rep that the best PR firm in the world would have a hard time overcoming. First, doctors in the past used insulin as a threat, creating an atmosphere of fear around the best diabetes medicine in the pharmacy. Second, in most cases, it was started far too late in the disease process, after the damage was already done. If grandma and grandpa had been started on inulin a decade earlier they'd be alive and kicking (with both feet) today. Third, type 2 diabetes is commonly inter-generational: And families have pretty good memories. More about that last one in a minute.
Luckily, the vast majority of the medical community has "gotten with the program." Insulin isn't held over patient's heads as a threat anymore. It's started in a timely manner now. In some practices it's viewed as a medicine of first resort, not of last resort. Most patients are told that insulin is in the cards from the very day they are diagnosed. The natural progression of diabetes is carefully laid out so that no fear or self-blame need exist down the road.
Still, family lore… that's not so easily changed. The mythologies, memories, misgivings and outright fear of insulin generated by the dark history of insulin's use will take much more time to cure.
But hopefully not the next 100 years of insulin's history.
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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Gone are the days of repelling Mission Impossible-like from the hospital ceiling to retrieve Charlie's medical files before the CDE entered our exam room. It's not that I don't care anymore about his A1c. Of course I care. Maybe in the past I was more consumed by it. For a very long time I so desperately wanted to see an A1c below 8. Now that we've been comfortably in the low to mid-7s for the last couple of years, there's just an expectation. It's become a little anticlimactic....