What Next When An Insulin Pump Is Stopped?
KIM A. CARMICHAEL, MD—Series Editor Washington University Dr Carmichael is associate professor of medicine, department of internal medicine, division of endocrinology, diabetes, and lipid research at Washington University School of Medicine in St Louis, Missouri. The author does not have any disclosures relevant to the content of this manuscript. Diabetes Q&A On the Alpha and the Omega of the Beta Cell (and More) Q: What is the safest approach to discontinuation of insulin pump therapy? A: Many persons with diabetes mellitus, particularly those with type 1, are completely dependent on exogenous insulin to sustain vital functions, even life itself, and without it may rapidly experience systemic metabolic decompensation. Persons who have an insulin pump rarely take long-acting insulin products, so an acute interruption of insulin delivery could have sudden, possibly catastrophic consequences, such as intracellular acidosis, extreme hyperglycemia, and organ failure. Insulin pump therapy is frequently interrupted in a number of scenarios, both unintentional and intentional. The infusion set may become inactive as a result of trauma, kinking, or obstruction, or it may simply run out of insulin because of patient forgetfulness, confusion, poor communication to health care providers, or lack of availability of a replacement set. Pumps may be discontinued in preparation for inpatient or outpatient procedures, radiologic tests, or surgery, or simply when patients are admitted to an emergency department or inpatient bed. When insulin pump therapy stops, clinicians and patients need to adjust treatment rapidly and effectively to prevent problems caused by acute insulin withdrawal. Often patients have established “backup orders,” and all inpatient order sets pertaining to ins Continue reading >>
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Stopping Metformin: When Is It Ok?
The most common medication worldwide for treating diabetes is metformin (Glumetza, Riomet, Glucophage, Fortamet). It can help control high blood sugar in people with type 2 diabetes. It’s available in tablet form or a clear liquid you take by mouth before meals. Metformin doesn’t treat the underlying cause of diabetes. It treats the symptoms of diabetes by lowering blood sugar. It also increases the use of glucose in peripheral muscles and the liver. Metformin also helps with other things in addition to improving blood sugar. These include: lowering lipids, resulting in a decrease in blood triglyceride levels decreasing “bad” cholesterol, or low-density lipoprotein (LDL) increasing “good” cholesterol, or high-density lipoprotein (HDL) If you’re taking metformin for the treatment of type 2 diabetes, it may be possible to stop. Instead, you may be able to manage your condition by making certain lifestyle changes, like losing weight and getting more exercise. Read on to learn more about metformin and whether or not it’s possible to stop taking it. However, before you stop taking metformin consult your doctor to ensure this is the right step to take in managing your diabetes. Before you start taking metformin, your doctor will want to discuss your medical history. You won’t be able to take this medication if you have a history of any of the following: alcohol abuse liver disease kidney issues certain heart problems If you are currently taking metformin, you may have encountered some side effects. If you’ve just started treatment with this drug, it’s important to know some of the side effects you may encounter. Most common side effects The most common side effects are digestive issues and may include: diarrhea vomiting nausea heartburn abdominal cramps Continue reading >>
Diabulimia: The Dangerous Way Diabetics Drop Pounds
At age 14, Erin Williams was tired of medicine. Williams was diagnosed as a type 1 diabetic at age 11, and after three years of enduring a never-ending regimen of insulin shots and strict diet restrictions, she was frustrated. Embarrassed by her disease, she kept it a secret from everyone but her closest family and friends. At birthday parties, she made up excuses about why she couldn't have soda or cake. When a classmate saw her drinking juice boxes in the nurses office, she endured weeks of being called the "juice box thief" rather than just tell her classmates she had low blood sugar because of diabetes. Eventually, Williams rebelled the only way she could, she decided not take her insulin. She just didn't want to adhere to the strict diet and medical regimen even though it was vital to her health. "It wasn't this dramatic moment," recalled Williams. "It was mostly like I want to be like everybody else." The next morning when Williams woke up, she felt fine. "Well, nothing bad happened to me," Williams remembered thinking. "It creeps up on you. That's how it does it." Emboldened by her experiment, she continued to restrict her insulin. Without a regimented amount of insulin in her body to process glucose, Williams' body started to burn through fat and muscle. She lost weight very quickly even as she ate all the same foods. Classmates started commenting on her weight loss and remarked that she looked great. "You hear all these things and you're like, 'This is the greatest thing in the world,'" said Williams. "It takes a hold of your life like nothing else." After living with type 1 diabetes for three years, Williams was exhibiting the first signs of a disorder often called diabulimia. The term refers to the dual diagnosis of type 1 diabetes and an eating disorder. Man Continue reading >>
Ask The Diabetes Team
Question: From Whitworth, United Kingdom: How long can someone live without insulin? Answer: The fact that you are asking the question has me suspiciously worried! I hope you are not trying to hurt yourself or planning to see how long you can go without insulin. The answer, perhaps, mostly lies in how long the person has had type 1 diabetes. For someone like yourself, who indicated that you have had diabetes for more than 10 years, you MIGHT be able to live for 7 to 10 or so days without insulin. But, the death would be awful and difficult and not peaceful. You would begin to have much urination and be extremely thirsty; but, you would also develop abdominal pain and get nauseated and vomit so you might drink but not be able to keep anything down with all the vomiting. You would start to get achy and sore and could have a terrible headache as your brain began to swell! You would have blurred vision and would begin to become delirious before you probably would go into a coma and become brain dead. The death would be awful to watch and impossible to bear by those that love you. And even if you did not progress that far to death, if there were too much delay before you could get taken to an emergency room, the damage may already have been done and it might be too late to reverse matters back to normal. DO NOT OMIT YOUR INSULIN DOSES. Additional comments from Dr. Tessa Lebinger: Some children and teenagers are so dependent on insulin, they could develop life threatening ketoacidosis in less than one day if they skip their insulin, especially if they are sick with another illness. Most people who make no insulin are very uncomfortable within 12 hours of missing a dose. People who are still making a lot of insulin and are still in the remission phase, may be able to stop insu Continue reading >>
The Effects Of Stopping Metformin
The medication metformin is a drug in the biguanide family that is used to treat type 2 or adult-onset diabetes mellitus. Drugs.com notes that metformin is often the first prescribed medication for individuals with type 2 diabetes and may also be used in combination with other diabetes medications or insulin. This medication is sold under the brand name Glucophage, Glucophage XR and Fortamet. Metformin helps to reduce glycemic or sugar levels in the blood in a number of ways. If an individual with type 2 diabetes stops taking metformin, they may experience serious immediate and long-term effects of uncontrolled high levels of blood glucose. Video of the Day A primary mode of action of metformin is increasing the sensitivity of the body’s muscles, tissues and cells to insulin--a hormone that is essential for transporting glucose from the blood to the body. Drugs.com notes that individuals with type 2 diabetes have insulin resistance. This causes the cells to ignore the effects of insulin and not allow glucose to be transported into the muscles and tissues where it is vital to produce energy. The body tries to compensate by secreting more insulin, which only leads to hyperinsulinemia in the blood. If a patient stops taking metformin, the type 2 diabetes effects occur due to insulin resistance causing symptoms such as severe thirst, hunger and urinary frequency. The chronic levels of hyperinsulinemia and hyperglycemia also contribute to diseases of the heart and vascular-blood vessel-system. Gluconeogenesis is the production of glucose by the liver. A storage supply of glucose is reserved in the liver and released into the bloodstream when the body requires energy due to stress or hunger. The MayoClinic.com notes that another one of the mechanisms of metformin to reduce Continue reading >>
Transitioning Safely From Intravenous To Subcutaneous Insulin
Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention. Common hospital uses for IV insulin include the perioperative setting, during the use of high-risk medications (such as corticosteroids), or during crises such as diabetic ketoacidosis (DKA) [1,2]. Other conditions such as hyperglycemic hyperosmolar state (HHS) and trauma frequently require IV insulin, as well as specific hospital units such as the cardiothoracic intensive care unit [3,4]. The correlation between hyperglycemia and poor inpatient outcomes has been well described in the literature [5,6]. The treatment of hyperglycemia using an IV Continue reading >>
Common Questions About Diabetes Medicines
How do I know if my diabetes pill is working? The best way to find out how well your diabetes pill is working is to test your blood sugar. Ask a member of your health care team what time of day is best for testing. You'll want to test when your diabetes medicine is expected to be most active in your body. Keep a record of your blood sugar levels (PDF) during that time to see if they're at or near your goal. If your levels are at or near your goal and you're not having any problems with the medicine, then it's probably working well. If you're still not sure, talk to your doctor or other member of your care team. Can I stop taking my diabetes medicine after my blood sugar is under control? It's reasonable to think that after a person gets good blood sugar control, it means the end of managing diabetes. But that's not the case. People with type 1 diabetes aren't able to make their own insulin, so they will always need to take insulin shots every day. For people with type 2 diabetes who are on medicine, the answer isn't as clear. Sometimes when people are first diagnosed, they start on pills or insulin right away. If the person also works hard to control diabetes with diet and exercise, he or she can lower the need for medicine and might be able to stop taking it altogether. As long as the person is able to keep blood sugar levels normal with diet and exercise, there isn't a need for medicine. However, type 2 diabetes changes over time. The change can be fast or slow, but it does change. This means that even if a person was able to stop taking medicine for a while, he or she might need to start taking it again in the future. If a person is taking medicine to keep blood sugar normal, then it's important to keep taking it to lower the chances for heart disease and other healt Continue reading >>
Stop The Metformin Madness
I have never been a fan of Metformin. It seemed too good to be true. Many years ago I had a conversation with a researcher about all of its possible therapeutic indications. His lab was actively pursuing the anti-cancer angle. That should have been a clue that Metformin might be causing more damage than we recognized, but it wasn’t. At that point, I was still enamored with the wonders of pharmacology and hadn’t yet begun my path toward understanding medication adverse reactions. Indeed, it wasn’t until very recently, when a family member began suffering from one of these reactions, that I began my investigation in full. This is what I learned. Type 2 Diabetes is Big Business The global profits from Type 2 diabetes medications rested at a paltry $23 billion dollars in 2011 but are expected to grow to over $45 billion annually by 2020. The market growth is bolstered in large part by the ever-expanding demand for therapeutics like Metformin or Glucophage. Metformin is the first line of treatment and standard of care for insulin resistance across all populations of Type 2 diabetics with over 49 million Americans on Metformin in 2011-2012. It is particularly popular in women’s health with an increasing reliance on Metformin for the metabolic dysfunction observed in women with PCOS, PCOS-related infertility and even gestational diabetes. Metformin is prescribed so frequently and considered so innocuous that it is sometimes euphemistically referred to as vitamin M. If we quickly scan the safety research for metformin, there is little immediate evidence suggesting any side effects whatsoever. In fact, in addition to controlling blood sugar by blocking the hepatic glucose dump, this drug is suggested to promote weight loss, increase ovulation in women, (thereby helping a Continue reading >>
Can You Ever Stop Insulin?
Once you begin using insulin to treat type 2 diabetes, can you ever get off it and go back to medications? — Anne, Minnesota For someone to go back to oral diabetes medicines after starting insulin, the pancreas must be able to produce enough insulin to maintain normal sugar levels. That being said, there are several instances in which insulin injections may be stopped. Here are a few: 1. In some individuals who have had untreated or poorly controlled diabetes for several weeks to months, glucose levels are high enough to be directly toxic to the pancreas. This means that the pancreas has not completely lost its ability to produce the critical level of insulin, but it does not work properly as a result of high glucose levels. In this instance, injected insulin can be used for several days or weeks to reduce glucose and help the pancreas to revert back to its usual level of functioning — a level that can control glucose supported by oral medicines. Once this occurs, insulin can be stopped. Remember, oral diabetes medicines work well only if the pancreas can still produce and release insulin. 2. Sometimes insulin is given during an acute illness such as an infection, when glucose levels can be high and the demand for insulin is greater than the pancreas can handle. After the illness is treated adequately, oral medicines can be started again. 3. Many obese individuals with diabetes who require insulin can reduce their dose or control their diabetes by taking oral medicines if they lose weight. However, the choice of insulin to manage diabetes does not always come after exhausting all oral or non-insulin options. Insulin has several advantages and is now more frequently introduced early in the management of type 2 diabetes. Continue reading >>
Long-term Use Of Diabetes Medication, Liraglutide, May Burn Out Insulin-producing Cells And Raise Blood Sugar
Long-Term Use Of Diabetes Medication, Liraglutide, May Burn Out Insulin-Producing Cells And Raise Blood Sugar Liraglutide, a popular drug that promotes better insulin control in type 2 diabetes patients, may wane in effectiveness when used long-term, a new study suggests. Above, a home hemoglobin A1C test used to monitor blood sugar. Alan Levine, CC BY 2.0 A popular type 2 diabetes drug known to lower blood sugar by stabilizing insulin levels may lose its mojo the longer its used, new research published Thursday in Cell Metabolism suggests. Studying mice with transplanted human pancreatic cells, the authors found that long-term daily doses of liraglutide (over 200 days) gradually weakened the cells ability to produce insulin in response to glucose. Worse still, while liraglutide did at first reduce blood sugar levels, the subsequent weakening created a rebound effect and led to levels higher than they would have been otherwise. "Given the lack of clinical studies on the long-term effect of these drugs in diabetes patients, this is a very important discovery," said lead author Dr. Midhat Abdulreda in a statement , Abdulreda is also a member of the Diabetes Research Institute at the University of Miami Miller School of Medicine. Liraglutide, first approved as Victoza by the FDA in 2009, and its cousins work by mimicking the natural hormone that regulates insulin secretion, GLP-1 . GLP-1 ordinarily prompts insulin release in the presence of evaluated glucose, which helps keep blood sugar at a Goldilocks level (just right). For people with type2 diabetes, however, that process is thrown out of whack, and liraglutide, along with other interventions like diet and exercise , is used to regain balance. And as the researchers note, theres been no disagreement over liraglutides Continue reading >>
Stopping Diabetes Medicines
“I want to get off some of these drugs,” Ellen told me. “But my doctor says I need them. I’m on three for glucose, two for blood pressure, and one for depression. They’re costing me hundreds every month. What can I do?” Ellen is a health-coaching client of mine, age 62 with Type 2 diabetes. She works as an executive secretary in an insurance company. It’s stressful. She’s usually there from 8 AM until 6 PM or later and comes home “too tired to exercise.” She mentioned that just “putting herself together” for work every day requires an hour of prep time. “You have to look good for these executives,” she says. I asked about her drugs. She said she takes metformin (Glucophage and others), sitagliptin ( brand name Januvia), and pioglitazone (Actos) for diabetes, lisinopril (Privinil, Zestril) for blood pressure, simvastatin (Zocor) for cholesterol, and paroxetine (Paxil) for depression. Her A1C is now at 7.3%, down from a high of 9.9% a year ago, when she was on only two medicines. “I think the drugs are depressing me,” she said. “The cost, the side effects… I have nausea most days, I have cough from the lisinopril. That doesn’t help at work. I don’t know what’s worse, the drugs or diabetes.” What would you have said to Ellen? Although I strongly believe in reducing drug use, I told her what most experts say, that she can get off some, possibly all diabetes drugs, but it will take a lot of work. Asqual Getaneh, MD, a diabetes expert who writes for Everyday Health, says that doctors want to be “assured that an A1C will stay down” if a person goes off medicines. She says doctors usually won’t reduce medicines until A1C drops below 7.0%. In the ADA publication Diabetes Forecast, pharmacist Craig Williams, PharmD, writes, “Unf Continue reading >>
Long-term Use Of Diabetes Medication, Liraglutide, May Burn Out Insulin-producing Cells And Raise Blood Sugar
A popular type 2 diabetes drug known to lower blood sugar by stabilizing insulin levels may lose its mojo the longer it’s used, new research published Thursday in Cell Metabolism suggests. Studying mice with transplanted human pancreatic cells, the authors found that long-term daily doses of liraglutide (over 200 days) gradually weakened the cells’ ability to produce insulin in response to glucose. Worse still, while liraglutide did at first reduce blood sugar levels, the subsequent weakening created a rebound effect and led to levels higher than they would have been otherwise. "Given the lack of clinical studies on the long-term effect of these drugs in diabetes patients, this is a very important discovery," said lead author Dr. Midhat Abdulreda in a statement, Abdulreda is also a member of the Diabetes Research Institute at the University of Miami Miller School of Medicine. Liraglutide, first approved as Victoza by the FDA in 2009, and its cousins work by mimicking the natural hormone that regulates insulin secretion, GLP-1. GLP-1 ordinarily prompts insulin release in the presence of evaluated glucose, which helps keep blood sugar at a Goldilocks level (just right). For people with type 2 diabetes, however, that process is thrown out of whack, and liraglutide, along with other interventions like diet and exercise, is used to regain balance. And as the researchers note, there’s been no disagreement over liraglutide’s ability to do exactly that in the short term, although the drug does carry a wide range of side-effects and doesn’t work for everyone. But research on its longer-term effects, spanning years' worth of use, has been lacking until now. "We also need to take these results into account before prescribing blood-sugar suppressing GLP-1 analogues when p Continue reading >>
Why Insulin Use Isn't Always Permanent For Type 2 Diabetes
Weight loss and exercise may reduce your need for insulin.(HEALTH/FOTOLIA) If your doctor puts you on insulin, it's not necessarily permanent. Unlike people with type 1 diabetes, who need insulin to survive, people with type 2 diabetes use insulin as just one more tool to control blood sugar. You may be able to go off insulin if you can get your blood sugar under control using diet and exercise. "A person who is very, very obese or very heavy will find that if they lose a large amount of weight, their insulin requirements or their oral medication requirements may drop tremendouslyeven disappear," says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. Taking insulin just after diagnosis may also make it easier in the long term to control your blood sugar with diet and exercise, according William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta. Stopping Insulin Some people may be able to stop taking it Watch videoMore about using insulin Glucose toxicity "When the sugar has been running high it creates in and of itself a resistance to other things to bring it down. It's a term we call glucose toxicity," says Dr. Bornstein. "So let's say that somebody comes in and their blood sugar is running pretty high and they want to try diet and exercise. It's less likely that the diet and exercise will work to bring it down. "So we might use medication for a period of time, bring it down, then stop the medication and let that individual have a period of time to try diet and exercise and see if that'll work to keep it down," says Dr. Bornstein. If you've developed diabetes recently and needed insulin right away, there's a better chance that you may be able to eventually reduce your dose or even stop taking insulin if you e Continue reading >>
Diabetic Put Her Life At Risk To Lose Weight: Mother Stopped Taking Her Insulin Injections After Ballooning To 19 Stone
A diabetic mother whose weight ballooned during pregnancy put her life at risk when she stopped taking her insulin medication in a bid to slim down. Hayleigh Juggins ignored doctors' advice, halting the treatment for her diabetes having blamed the hormone for her weight reaching 19st. The 20-year-old was diagnosed with type one diabetes when she was 15 years old. When she fell pregnant three years later, she began taking high doses of insulin, which she claims led to rapid weight gain. By the time she gave birth when she was 19, she weighed 19st and was wearing size 22 clothes. Horrified, she decided to disregard doctors’ instructions to take insulin after each meal and subsequently found herself shrinking. Stable today at 10st 10lb, Miss Juggins says that despite being pleased at gaining her dream figure, she will never again risk serious damage to her health by going against medical advice. She said: ‘There was a war within me - on the one hand I was distraught at having gained so much weight during pregnancy, but on the other I knew what I was doing was bad for me. Indeed, experts stress that skipping insulin can have devastating consequences, including brain damage and death. Libby Dowling, Diabetes UK Clinical Advisor, said: 'Skipping insulin to lose weight is extremely dangerous. This is because if you haven't got enough insulin in your body your blood glucose will get too high, which can lead to devastating health complications. 'In the short term it can lead to diabetic ketoacidosis, an extremely dangerous condition that requires immediate medical attention and treatment in hospital, and can even be fatal. And in the long term skipping insulin can lead to complications such as blindness, stroke and amputations. 'It is crucial that people who are omitting the Continue reading >>
What Are The Consequences If A Patient Stops Taking Insulin In Type 1 Diabetes And Is Type 1 Is Curable?
Thank you for A2A. I guess I am qualified enough to answer having worked at the treatment of T1D for almost 1.5 years. TLDR : There are adverse effects of insulin weaning. There is no cure of T1D yet. But we do have promising treatments under Phase 2 and 3 clinical trials (later stages of drug development) so there is hope. We might see a successful drug in coming decade. Animesh Agrawal has covered etiology (the cause of disease) very well. I will add a few things here. You are not alone : Type 1 or juvenile diabetes affects approximately 70,000 children under the age of 15 every year and around 3.2 million people in the world die due to diabetes or its related causes per year. We don’t know our enemy and hence winning it is difficult : Type I diabetes is an autoimmune disorder (our defence mechanism offends our body) and it may develop at any age. Incomplete understanding of the mechanism of disease development and progression prevents the development of any rationally designed drug. The reasons of T1D are varied and include susceptible genes , enterovirus infection, etc. Presently the treatment involves insulin administration by injection or pump. Both are invasive methods, painful enough and hence non-compliance is usually observed in patients. The present treatment is also an economic burden to patients. Consequences of stopping Insulin in T1D : In layman terms there can be following, Preliminary symptoms: Fever, headache, gastrointestinal disorders, reduction in weight Symptoms in longer run: metabolic disorders, vulnerability to other diseases But these are very generalised, symptoms depend on age group and other factors like gender, extent of destruction of beta cells (cells that make insulin in body). See Nandan Karn 's answer for details. Treatment : Insulin Continue reading >>
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