Is it possible to discontinue insulin

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Limit characters or approximately words. The following information is required and must be completed in order to submit a comment:. Thank You. Your comment submission was successful. Please allow up to 2 business days for review, approval, and posting. This Issue. Views 8, Citations View Metrics. Twitter Facebook More LinkedIn. Original Investigation. Jonathan Z. Karter, PhD 1 ; Richard W. Key Points Question Is insulin treatment used less frequently and discontinued more often among older individuals with poor health compared with those in good health?

Study Design and Setting. Clinical Measures. Health Status Category Definition. Insulin Use and Discontinuation. This was annoying, since I had to keep track of which pills to take and when.

I hated the idea that I needed that next pill in order to lower my blood sugar. So you can imagine how I felt when my doctor put me on Novolin, which is injectable insulin. It was such a pain—literally, since I had to shoot myself up twice a day, every day, in my belly. Luckily, I found a job that I love with the City of Lafayette in Indiana, which offers great health insurance.

This meant that I could see my doctor, get my lab work, and cover the costs of the medication. I was trying to change my diet, cutting meals, doing shake substitutes, but nothing was working. I thought Virta would just be a different fad diet I would give up on eventually. But it was covered, and it sounded interesting, so I decided to give it a shot. Overall, I went from an A1c of 7. I've read that this can happen — that insulin can contribute to weight gain. What can I do? I try to watch what I eat and have recently joined a fitness club, but I haven't had much success yet.

Any advice? Insulin can, in fact, lead to weight gain. Here's how it works:. Insulin is a potent hormone that regulates glucose, fat, and protein metabolism. In many cases, people with type 2 diabetes start insulin therapy when oral medicines cannot or no longer control their glucose levels.

This means that blood glucose levels in the body have been elevated for an extended period of time. In this state, the body does not metabolize glucose, fat, or protein in a well-regulated or efficient way. Cells that require glucose to function properly begin starving because of inadequate amounts of circulating insulin.

Fat metabolism becomes abnormal, which can lead to high triglyceride levels. The body's metabolic rate then increases as it tries to convert this fat into a source of energy. These abnormalities are usually corrected when you begin insulin therapy. The body begins using glucose better, and the metabolic rate declines by about five percent. Insulin also helps the body gain fat-free mass, but on the flip side, it also helps it store fat more efficiently.

Therefore, efficient glucose and fat metabolism and the reduction in metabolic rate cause most people to gain four to six pounds during the first two to three years of insulin therapy.

Individuals who had poor glucose control, or who lost significant amounts of weight before beginning insulin treatment, usually experience the most weight gain.

Losing weight in general requires persistent attention to energy balance — that is, the number of calories you take in versus the number you burn. During insulin therapy, the body does not need as much food to get the energy it requires, so reducing your caloric intake is quite important.

This should be accompanied by an exercise regimen, as you have begun, to expend at least to calories a day. In addition, you should consult with your doctor to consider other kinds of diabetes treatments that could mitigate the weight gain.

These include metformin , an oral medication that prevents weight gain; an insulin analogue called detemir, which has been shown to cause less weight gain than NPH insulin; and exenatide , an antidiabetes injection that can lead to weight loss. I was diagnosed with type 2 diabetes in Some of the episodes of insulin discontinuation analyzed in the study, while recorded by healthcare providers, may have reflected patient-driven non-adherence.

However, based on our clinical experience, patients who are not adherent to their medication that their provider feels is indicated for them seldom have it discontinued in their EMR record — consistent with the finding that patient preference was not commonly cited as a reason for insulin therapy discontinuation in the study data. There was a large amount of missing laboratory data; however, analyses that did not include variables with large amounts of missing data and analyses that imputed missing data had very similar results.

Finally, as an observational study, the analysis of factors associated with insulin discontinuation could not identify causal relationships but only associations. In summary, this study has confirmed that discontinuation of insulin therapy countenanced by healthcare providers is a distinct clinical phenomenon whose risk factors and reasons are different from the more widely studied medication non-adherence.

While many patients discontinued insulin therapy, in most cases discontinuation appeared appropriate. Frequently it was made possible by patients achieving blood glucose control by alternative means, either lifestyle changes, additional non-insulin diabetes medications, or both. Adverse reactions to insulin e. Many of the factors associated with insulin discontinuation identified in the study e.

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