The Agency For Healthcare Research and Quality (AHRQ) in the USA has made an interesting report on the use of premixed vs long acting insulins for Type 2 diabetics. Here is the link.
The report states that 16% of Type 2 diabetics in the USA use insulin alone to control their diabetes. It is reported, elsewhere, that there are approximately 24 million diabetics in the USA and roughly 10% of those are Type 1’s. That means that the USA has 21.6 million Type 2’s and 2.4 million Type 1’s. If 16% of the Type 2’s use insulin alone then there are about 3.5 million Type 2’s and 2.4 million Type 1’s who use insulin alone. So there are about 1.1 million more Type 2’s than Type 1’s who use insulin alone to control their diabetes in the USA. I was rather surprised.
Richard, that report seems ‘weak’ to me. Alot of the summary results actually state “The evidence was too weak to make a conclusion.” I can’t ascertain the result. Which is better? Premix or long acting? I don’t understand why this comes as a surprise to you, the idea that more T2s use insulin than T1s. There are millions more T2 diagnosis than T1, as you know. Millions more!
I hope that this kind of study is viewed in a positive light that lets folks know that insulin is a perfectly acceptable way to control, manage, and live with this disease. And to say “Use Insulin Alone” is simply criminal. I’m sure that is not what was meant. But I feel I must add that no diabetic can “Use Insulin Alone” to manage their disease, we must all take care in many many other ways!
Karen, the point being made, as I see it, is that there are more T2’s than T1’s whou use insulin without meds I knew there were more T2’s who used insulin for the reason you stated but with no meds to help them with their inulin resistance, that is what surprised me. I thought far fewer T2’s would have stopped meds since doing so means much larger insulin dosages due to their insulin resistance. I am T1 but I developed insulin resistance in the 1990’s and my insulin used per day increased 40%. A T2 med (Avandia) was added to my care package and my insulin dosages soon returned to normal. So even I do not use insulin alone.
Thanks, Richard. I see what you are saying but I still think this study/report is weak.
I was fascinated by it even though I couldn’t really grasp it’s intent. I thought it was more about this statement - “In the management of type 2 diabetes, the place of premixed insulin analogues in relation to other insulin regimens and noninsulin antidiabetic agents is as yet unclear.” And the conclusions were certainly in line with that statement. I am also T1 and require insulin but have not become resistant at this point. Should I find myself unable to maintain excellent control with my fast acting insulin however, I’ll be the first one at the docs door looking for another solution like you have.
Thanks for the analysis. That will put paid to the stupid myth that type 2 don’t need insulin that you loose a bit of weight and your fine.
I have tried to add metformin to my insulin to combat the insulin resistance but after 3 weeks I get so tired I cannot get out of bed. not sure but I think it poisons my liver. I think based on what you said possibly adding avandia may do something it never did without insulin. So far the only thing that works is a massive amount of exercise. Read Diabetes self management web site about that vitamin C and vitamin E UNDID the beneficial effects of exercise. Apparently leaving the free radicals alone is good!.
Richard, your statistics about the percentages of T1 and T2 are not up to date. According to John Walsh, author of “Pumping Insulin” (and lots of other researchers such as Irl Hirsch), about 10% of all diabetics are classic onset Type 1 diabetes (childhood and young adult). About 10-15% of all diabetics are adult-onset Type 1 diabetes (sometimes called latent autoimmune diabetes of adults or LADA), and about 75% of all diabetics are Type 2. Doing the math, there are LOTS more people with Type 1 autoimmune diabetes using insulin than there are Type 2 diabetics using insulin.
Hello Melitta, thanks for the information. If I am not badly mistaken the usual point of view is that Type 1 is the 10% you mentioned and the LADA and MODY groups are Type 1.5. Many reports seem to look at it as Type 1 and “non-Type 1” so the Type 1.5’s seem to be combined with the Type 2’s. I know that does not make sense but many reports online do that. Otherwise the statistics they give are inaccurate, as you have suggested. I don’t disagree with you and Mr Walsh, it makes good sense but reports that say there are 10% Type 1’s and 90% Type 2’s without any mentioning of LADA leads me to that conclusion.
Hi Richard: Sadly, it is because adult-onset Type 1 diabetes is completely ignored that this misinformation/out-of-date information is still out there. Yes, the adult onset Type 1’s are being lumped in with Type 2 in those 10%/90% statistics. According to NIH, LADA is Type 1 in adulthood–it is autoimmune diabetes. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus (as published in ADA journals), “Although the specific etiologies of [Type 2] diabetes are not known, autoimmune destruction of beta-cells does not occur.” So LADA clearly should not be in the Type 2 category. One researcher says, “LADA is not a latent disease; therefore, autoimmune diabetes in adults with slowly progressive beta-cell failure might be a more adequate concept.” So yes, there are far more Type 1’s on insulin than Type 2’s, if you do the math.
Could you comment on the circumstances that caused you to become insulin resistant. How much is a normal insulin consumption without insulin resistance? Many type 1 diabetics need about 0.5 unit per Kg of body weight per day. But some type 1 need a lot less you wonder if their pancreases are still working a bit.
