My doctor, the internist, not the ENDO, told me that insulin usage can cause atherosclerosis.
Has anyone else heard this?
[quote=“lh378, post:1, topic:52364”]
atherosclerosis
[/quote]Nope, that’s a new one and all I can say is Wha??? Your internist needs to go back to school. Here are some “facts” on atherosclerosis:
Atherosclerosis is a slow, progressive disease that may begin as early as childhood. Although the exact cause is unknown, atherosclerosis may start with damage or injury to the inner layer of an artery. The damage may be caused by:
•High blood pressure
•High cholesterol
•High triglycerides, a type of fat (lipid) in your blood
•Smoking and other sources of tobacco
•Insulin resistance, obesity or diabetes
•Inflammation from diseases, such as arthritis, lupus or infections, or inflammation of unknown cause
Diabetes is a known risk factor, but insulin usage is not a known cause.
When ever our doctors tell something like this we should just ask for references. In this case there will be no scientific paper to establish such a causality. It is very simple: you can not separate the risk of uncontrolled diabetes from the risk of using insulin. There is not even an agreement that patients using insulin are using more insulin than they would naturally use. In 100 years we all will be dead - that is the only truth there is. The rest is a myriad of individual factors contributing to but not causing negative or positive outsomes like atherosclerosis.
I also ask myself why your doctor is focusing on the potential negative outcomes of a medication you have no choice about? This fear mongering does not support you. So why going to a doctor that is insensitive and not supportive?
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So to be clear, this is about hyperinsulinemia (higher than normal levels of insulin). This is often observed in insulin resistant type 2. And it turns out hyperinsulinemia is associated with atherosclerosis. But not causally, rather it is part of the range of metabolic problems in diabetes and is more likely caused by high blood sugars (for which there is evidence of causality). It turns out association does not mean causality as @Holger says. But don’t expect a clinician to understand this. My experience is that most clinicians don’t actually read or know any of the literature, they get most of their information by word of mouth, anecdote and other colleagues. In this case there is evidence that in fact atherosclerosis is not caused by hyperinsulinemia.
I would urge caution in attempting to correct or inform your doctor. Doctors have ego problems and most do not accept such information from a “mere patient.”
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Brian, I’ve held my tongue for a long time, but I must speak out now: Enough with the Doctor bashing already! We are not all narcissistic idiots… The vast majority of us make a lot of selfless personal sacrifices in order to work long hours (many of which are “non-billable”) caring for and listening to our patients!
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I’m sorry if I painted all doctors as egotistic idiots. I’m sure that the majority got into the field because they cared and I’m sure they do listen. But they don’t generally listen to the patient to learn anything about the field, they listen so that they can make a diagnostic or treatment decision. Doctors don’t want to hear what a patient has learned off the internet, let alone about a new study. I have found way too many doctors who don’t know the difference between association and causality and have a weak understanding of statistics. My own endo did not know the difference between absolute and relative risk let alone know what number needed to treat means.
Please take my comments not about an individual but on the system. Our system fails to educate doctors with a basic understanding of scientific method and sets them up in a paternalistic system where they are encouraged to wield authoritative knowledge as power in a way that is often unhelpful. As a patient I need to become smart about my chronic disease because I need patient centered care and I cannot always depend on my doctors for sound knowledge about my condition.
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Brian, thank you for your thoughtful reply; I appreciate it!
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I’m afraid I’m with Brian on this. I’ve heard too many dismissive rejections not to be aware of it.
Are all doctors like that? Of course not. Even a majority? Most likely not. But many are. We can discuss the factors that contribute to that–societal awe, overwork, career burnout, educational tropes, etc., etc.–til the cows come home, but that’s a different discussion and a very long one. I haven’t a shred of doubt that most doctors enter the field for the right reasons, sincerely felt.
But a significant number do adopt the “not invented here” mental wall when information comes from someone without the requisite certificates. The syndrome is real. And nontrivial. For that matter, it’s not limited to doctors. You find it in some degree in nearly every profession.
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Way to take the topic off on some other tangent! Atherosclerosis is for SURE something to avoid, ih378. So if your internist is concerned and even if mistaken on the statement that insulin is a cause it does not mean that you should ignore any advice regarding treating and/or keeping it at bay. Your diabetes for sure increases the risk. Take care 
The key thing is that you should not be denied insulin or be told to inappropriately reduce your insulin levels in the mistaken belief that this is a good way of avoiding atherosclerosis and keeping healthy. That is just harmful advice.
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What you just said makes sense.
The doctor thinks that oral meds, if sufficient, should be the way to manage BG. I tend to think that insulin is better than oral meds.
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You just pushed the hottest of my hot buttons, as anyone who knows me will attest. Keeping insulin as the last resort pretty much guarantees that that is precisely what it will be.
I think doctors can be “insulin resistant” and not want to prescribe insulin for fear that the decision to initiate insulin therapy will make them liable for any problems (like hypos). For someone like an internist this can be a big problem, even if they do have some training in diabetes they probably don’t have the deep competence and experience to be comfortable starting you on insulin.
If you are having well controlled blood sugars fine, but it is inappropriate for a doctor to wait around until your blood sugars are out of control or you end up in the hospital before prescribing insulin. If you are diagnosed T1/LADA then you should have access to insulin as soon as you need it. I’m sure if @Melitta is listening she will pipe in as well.
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And the sooner the wizards start viewing their patients in a less paternalistic ways, the sooner the trumpeted “patient-centered” care revolution can take root.
The best thing like I about my current endo is that she hears me and respects the competence that I use to deal with my diabetes.
Quite so. But there are other, less worthwhile motives also. I saw a survey a few years back that indicated large numbers of doctors refrained from prescribing insulin because they thought their patients were afraid of needles. They surveyed the patients in the same study and it turned out that only about half as many really were as the doctors believed. Lack of communication, yet again.
Have you attended medical school and felt that the education in science was lacking?
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It’s paradoxical that doctors have the “hollow” authority that the credential brings without the deep competence needed to give trustworthy detailed advice on how to dose insulin. Then they’ll cast an unjustifiably skeptical eye on the curious and successful diabetes patient with hundreds of thousands of hours of insulin experience just because they don’t have the MD after their name. I’d rather be in my position than theirs.
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Agreed… As a forum full of people who absolutely owe our lives to the labor and skills of doctors, I find much of the tone directed toward them on this forum to be pretty ironic…
I’d go out on a limb here and wager that those who suggest that their education is lacking haven’t known many people while they were working their way through med school, internships, residencies, fellowships, or any other part of the 12-20 years of post secondary education, plus ongoing continuing education throughout their career that they bring to the equation when making the very decisions that keep us alive. As a group, I feel that we act pretty ungrateful sometimes in that regard.
Yes the US healthcare system is kind of a mess, but the hardworking healthcare professionals within it aren’t the source of the problem.
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In the context of this discussion, the comments about education being lacking do not refer to quantity or intensity, only content. I am utterly confident in saying that no one here questions or minimizes the amount of work or dedication involved. Not in any way. It’s what is taught that reveals gaps, not how much. And if it reflects anything on anyone, it’s the faculty. Not the student.
By way of analogy, Peter Drucker, one of the gurus of management science, defined the difference between efficiency and effectiveness this way: Efficiency is doing things right. Effectiveness is doing the right things.
For people with Type 1/LADA, we depend on exogenous insulin for survival. In some cases, some of the meds for Type 2 may be useful for a person with Type 1/LADA, but only as an adjunct to insulin therapy (and Type 1s should never use sulfonylureas). Would the internist tell the parent of a child with Type 1 that oral meds (for Type 2) should be used instead of insulin? Of course not, and why should the treatment be different for an adult with Type 1? And, for the newly diagnosed, early intensive insulin therapy (whatever is “intensive” for the patient’s particular situation) preserves beta cell mass and leads to better health outcomes (see Bruce Buckingham MDs studies if interested).
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