Needle of doubt

Rxpress

Most people in this country have faced a diabetes treatment debate insulin or oral hypoglycaemics either directly or for a relative or friend. This is not surprising at all because there are 62.4 million diabetics in India (as per the phase I study by ICMR). There is no final word on which is better yet as doctors are grappling with various permutations of treatment, some personal preferences and emerging data on the most appropriate combination of drugs for optimum management of blood sugar.

Starting a patient's treatment with insulin almost always proves to be a tall ask because of its association with the intractability of the disease. This perception is not correct, even though insulin is the second or third option to manage diabetes, behind a range of oral drugs which have various side effects.

Insulin is a hormone secreted by the beta cells of the islets of Langerhans of the pancreas. It is associated with key functions related to carbohydrate and fat metabolism of the body. Diabetes or poor blood sugar control is linked to deficiency in either the quantity (type I diabetes) or the potency (type II diabetes) of insulin secreted in the body. For type I diabetes, often referred to as juvenile onset diabetes, insulin is the only option. The insulin vs oral medication debate kicks in for type II diabetes, where the cells' responsiveness to diabetes is reduced.

"Patients in India are very reluctant to get started on insulin. That is the greatest barrier for doctors because they have to be talked into agreeing to the treatment module. The principal reason is the fear of the needle as most patients still associate insulin with the thick needle used for blood tests. They do not know that a very fine needle is used for administering insulin. The second aspect is the perception that insulin is the 'last resort' in diabetes management. Depending on the timing of insulin use, it is possible for patients to get back to oral medicines or even go off them later if the beta cells are sufficiently revived," says Dr Anoop Misra, director and head, department of diabetes and metabolic diseases, Fortis Hospital.

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