In my experience, patients faced with the pivotal news that they can no longer control their diabetes with tablets and must start insulin often feel they’ve failed and are fearful of the seriousness of their condition and subsequent lifestyle implications. Insulin initiation is seen as the last resort. Patients with older family members with Type 2 diabetes may recall large needles, rigid dietary regimes and the very real fear of disabling hypoglycaemic events.
As healthcare professionals, we know that achieving good glycaemic control is key to preventing long-term micro and macro complications. Insulin is another tool in our medication suite to achieve this, with powerful beneficial results. We manage our patients fears with education, demonstrate new devices, simplify techniques and aim to empower them to take control. Doses are then titrated up and up to achieve a target HbA1c. One of the main side effects being weight gain. A long with the negative effects on self-esteem, this can set up a vicious cycle of increasing insulin resistance requiring ever increasing insulin doses and even more weight gain.
So could we use this opportunity to ‘prescribe’ radical lifestyle intervention to patients alongside their insulin start? It is often seen as either/or situation. But what about both? Delaying an insulin start is not always an option when diet, exercise and other medications are seen to have failed. We do know that even patients who have had Type 2 diabetes for many years can reverse their diabetes and reduce their medications. An insulin start requires active blood glucose monitoring which can help patients really connect with controlling their energy balance with amazing results: smaller carbohydrate portions, increasing activity levels, losing weight and feeling more in control. It can be a lightbulb moment. We emphasise that diabetes does not have to be progressive. Can we go further and demonstrate this with a careful, structured, exercise plan in alignment with an insulin regime?
There are practical implications for this treatment route. Ideally people with diabetes would be supported to exercise in person by specialised dietitians or nurses experienced in insulin dose adjustment, close to home and in a group for peep support and encouragement. These types of supervised ‘real life’ activities are usually outside the scope of traditional NHS 9-5, Mon-Fri healthcare activities. So here is the challenge – if patients want a holistic approach to well-being we need to start thinking creatively, diversify our offerings and bring our expertise closer to where patients live and work.
Green Shoots Dietetics are currently running POWER walking group in Cardiff. If you would like to find out more, refer your patients, or talk to us about setting up your own Exercise & Type 2 Diabetes programme, get in touch via email@example.com or call Sarah on 07876 221543.
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