I recently read an article titled, “Strategies for Insulin Injection Therapy in Diabetes Self- Management,” by the American Association of Diabetes Educators.  It stated that there is a lot of evidence showing the benefits of insulin therapy.  However, insulin continues to be under used in the United States compared to other countries.  Only 29% of adults with diabetes in the U.S. use insulin.  The results of two surveys recently completed showed that one-third of patients fail to take their insulin as ordered by the doctor and 29% skip their doses¹.  This tells us that there are many barriers to insulin use, resulting in poor blood sugar control and an increase in complications.

In spite of the importance of insulin therapy both doctors and patients try to avoid it.  Doctors tend to prescribe it as a last resort.  The Diabetes Attitudes, Wishes and Needs (DAWN) study showed that, in the U.S, insulin therapy is started later than in other countries².  The reasons were based on physician beliefs that insulin should be delayed and patient’s lack of education on insulin.

Patient barriers include:                                            

• False information on insulin

• They no longer have control

• Fear of needles and pain

• Weight gain

• Fear of hypoglycemia

• Too complicated to learn

Physician barriers include:

• Patient will not continue taking the insulin

• Patient will gain weight

• Patient resistance

• Patient lack of education

As an educator, I believe that insulin therapy should be started earlier in the treatment of newly diagnosed diabetes whether type 1 or type 2, control can be achieved sooner.  Patients can delay the onset of complications that occur too early and too frequently.   

Do you think adding insulin to your medication regimen would help you? 

^{1 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

^{2 Supplement to The Diabetes Educator Vol. 37. NO 6 American Association of Diabetes Educators  pg.2-7.}

Have you heard of the term “Dawn Phenomenon” or the “Somolgyi” effect? Many people with diabetes haven’t, and yet it happens quite often.

The “Dawn Phenomenon” is a sudden rise in blood sugar between 3:00am and 6:00AM. It occurs in type 1 diabetics and occasionally in people with type 2 diabetes. It is caused by the body’s reaction to hormones that are released when you sleep. The result is an increase in blood sugar due to lack of insulin in the blood stream.

The “Somolgyi” effect, also known as the “rebound” effect, is a period of low blood sugars followed by high blood sugars. It usually happens in the middle of the night. Normally this occurs as a result of taking too much insulin or an oral medication that works at the wrong time.  When the blood sugar is low the body releases hormones and stored sugar is released from the liver which also results in high blood sugars.

How do you know which one you have? This is the fun part! Your doctor will ask you to test your blood sugar between 2:00AM and 3:00 AM a few nights in a row. If the blood sugar is normal or high at this time, suspect the dawn phenomenon. However, if your blood sugar is consistently low during this time, you are experiencing the “Somolgyi” effect, caused by too much night time insulin or too small of a bedtime snack for the insulin given.

What can you do? Ask your doctor about an insulin pump to manage your diabetes.  One of the features that the pump can do well is stop the dawn phenomenon. You can set different basal rates to increase or decrease insulin according to your needs.

Feel free to share your “Dawn Phenomenon” or “Somolgyi” effect stories…what steps did you take to overcome this?

At work I educate people who have diabetes and many of them use an insulin pump to deliver their insulin.  During our conversations I always ask, “What are the features & benefits of your insulin pump?”  Since starting on the pump some people felt their control had improved and they felt more relaxed.  Another benefit mentioned was the move from multiple insulin injections and not having to stick themselves with a needle several times a day.  Since starting with the pump, they now change their site every three days which reduces the number of shots per day from approximately 12 every three days to one injection.  Each “insulin pumper” expressed the feeling of freedom, flexibility and confidence.  An Insulin Pump can be a life altering change.

P.S.  I wear an insulin pump too!