Contributor: Dr. Staci-Marie Norman, PharmD, DCES

First, let me start with HAPPY SPRING! Today I saw the first crocus of the season, and it did seem to brighten the overwhelming sense of dread that it seems most of us are experiencing. I know the past few weeks have been incredibly stressful on all of us with the “new normal” of COVID-19, but let me reassure you from the standpoint of a retail pharmacist, don’t panic about not being able to get refills on medications. Currently, there are no issues within pharmacies with the supply and receiving of medications. That being said, most insurance companies are also allowing you to fill your prescriptions up to 14 days early if you would feel better about having a little extra supply on hand so you can “hunker down” for 2 or 3 weeks if need be. Pharmacies are also considered vital community resources, like hospitals and grocery stores, so we will be open throughout this pandemic.

But let’s talk about something other than COVID-19. Have you ever heard someone say, or maybe you’ve said yourself, “I don’t want the needle” or, “my doctor says if I don’t do better, I’ll need the needle”? I have to say I’d be rich if I had a dollar for every person that has said something like this to me throughout my career. So why is there such a negative stigma when it comes to insulin, which is what the majority of people consider “the needle”? There are many reasons people might feel as they do, both internal and external. With the past stepwise approach to drug therapy for type 2 diabetes, insulin was the last step or looked at as a last resort. For many, this came with the feeling of failure to manage their disease. Health professionals, doctors, nurses, and pharmacists were just as much to blame for this negative attitude towards insulin. In the past, insulin has been delayed and, in some cases, used as a type of threat to try to scare people into trying harder with life-style modification or drug therapy. Thankfully this attitude has changed dramatically.

We now understand that type 2 diabetes is a progressive disease. Although in-range blood glucose can slow that progression, the condition will still progress. Part of this is the inability of the pancreas to produce enough insulin for the body’s needs. So, supplementing the body’s own faltering insulin production makes sense to maintain a healthy body. We also now understand that type 2 diabetes is more than just a lack of insulin; there are many other body systems to consider. Take the term insulin resistance. When I was in pharmacy school, we never even studied this, yet we know that this is the leading cause of type 2 diabetes. Insulin resistance makes the muscle and fats cells in the body less sensitive to the insulin we make. Insulin is needed for glucose to move through the cell walls to provide energy for those cells. Think of insulin being a key to open the cell door for glucose. If the lock and key don’t match, the door doesn’t open. This is basically what is happening with insulin resistance. The body tries to overcome this resistance by increasing insulin production. This increase in production can overcome the resistance for a period of time, but eventually the pancreas can no longer keep up with the demand. This is part of the progression of diabetes. We now have medications that work directly at the insulin receptor or indirectly by lowering blood glucose levels to help correct insulin resistance.

It was discovered that an intestinal hormone also plays a part in signaling insulin release from the pancreas. There is a reduction in the amount of this hormone in people with type 2 diabetes. Medications have been developed that mimic these intestinal hormones. Most of this medication class are injectable and used early in therapy because not only do they reduce blood glucose but have been found to decrease the risk of cardiovascular disease.

With the development of better insulins, this therapy is also being used earlier in treatment. Some people might even be started on insulin initially to help get blood glucose levels into target range, and then have that therapy backed down or discontinued. The introduction of insulin pen devices has also made the delivery of insulin easier and less scary for people. I have seen a significant shift in people with type 2 diabetes being more open to injectable therapy due to not having to deal with vial and syringes. Society, in general, also is making injectable therapy more acceptable. Just think about how many commercials you see on television that advertise an injectable medication for diabetes, rheumatoid arthritis, Chron’s disease, psoriasis, and so on.

I hope that if you are discussing the addition of an injectable medication to your diabetes regimen, you will look at it as a way to make you as healthy as possible versus a failure. Because maintaining good health is the ultimate goal of any therapy!

Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.