I am Dr. B Ramya, Diabetologist. Today I will talk about type 2 diabetes mellitus. The importance of short term insulin at the diagnosis of type 2 diabetes mellitus presenting with very high blood sugar. Type 2 diabetes can often remain unrecognized for years. Hence, it is not uncommon to find patients with very high blood sugar right at the time of the diagnosis. The HbA1c will be high. in such patients, there is a phenomenon called glucotoxicity which occurs. Let me explain what is glucotoxicity? We all know pancreas spread the insulin in response to blood sugar. And this is insulin which controls the blood sugar. Now, if the blood sugar remains elevated for a long duration of time, say months together, this prolongs exposure to very high blood sugar results in temporary suppression of pancreas cells which produce insulin.
Like any other injured organ of the body, the pancreas to need rest to recover from the stress. If not, it will not recover at all leading to loss of function. Hence, wherever there is glucotoxicity, it is essential for the pancreas to be rested. In such a situation where sugar is very high, we have 2 challenges to overcome: 1. To bring down extremely high blood sugar, 2. We have to do it without straining the pancreas. Now both these can be accomplished only by giving external insulin to the patient for a short duration of the time, say 3-4 weeks. After this, it can be substituted with oral antidiabetic agents. This will positively influence the long-term outcome of the patient.
There are a lot of myths about insulin. People think that if it is taken once, it has to be continued for a lifetime. But, it is not so. Insulin is only given for a short term to bring down the blood sugar level. At diagnosis, if you find very high blood sugar level and instead of giving short term insulin, giving a high dose of medications will result in longer time the depletion of the pancreatic insulin-producing cell. And ultimately the patient will need permanent insulin. It is just like riding over a sick horse. The pancreas is already stressed out because of glucotoxicity, hence this will result in premature loss of functioning of the pancreas. So, it is always better to go for a short course of insulin when blood sugar is very high in the initial stages. And then switch to the medications. Patients are already taking medications but still, their HbA1c is very high. So, even in that situation instead of directly increasing your dose, it is worth to give a short dose of insulin and then make other changes in the prescription. For more information, you can consult me through Lybrate.