Type 2 Diabetes - failure, blame and guilt in the adoption of insulin therapy.
Type 2 Diabetes is a progressive disease with an insidious onset, including decreased first-phase insulin secretion and mild forms of hyperinsulinemia caused by heterogenous factors such as genetic make-up, obesity and lifestyle. Decreased insulin secretion may already be a first sign of beta-cell damage, which is expected to develop into insulin resistance later and to result in progressive beta-cell deterioration and death. The disease has become highly prevalent in Western countries and is rapidly reaching epidemic proportions in the developing world. While the molecular mechanisms involved in the etiology of this disease remain relatively poorly understood, the United Kingdom Prospective Diabetes Study (UKPDS) has clearly demonstrated in several investigations that the adoption of insulin therapy in early phases of the disease is capable of attenuating or even preventing massive beta-cell loss and thus the severe metabolic syndrome and its late complications. This report aims to highlight the common psychological obstacles healthcare professionals are faced with when they are attempting early introduction of insulin therapy. Many patients typically underrate early signs and repress the fact that the disease is developing while they are vainly attempting to keep to lifestyle changes like New Year's resolutions. However, there is also reluctance on the part of the healthcare professionals. At the same time, patients' reservations about needles and fear of hypoglycemia can be removed simply by educating patients about the relatively low risk of hypoglycemia. Coupled with enhanced healthcare services, this strategy can overcome psychological insulin resistance and contribute to the maintenance of good metabolic control.
Phillips
Patrick
P
Department of Endocrinology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville SA 5011, Australia. patrick.phillips@nwahs.sa.gov.au