X-PERT Insulin Programme re-launch! “Reduce or omit”

Author: Dr. Sean Wheatley, PhD – Science and Research Lead/29 September 2017

We are pleased to announce that we are re-launching our X-PERT Insulin programme! This programme is designed for anybody who takes insulin to manage their diabetes (Type 1 or Type 2). The theme of the new and improved programme is “reduce or omit”, with a focus on helping people to make some lifestyle changes that can help them reduce the amount of insulin they need to take to manage their blood glucose levels.

The traditional approach

It is common for education and advice for people taking insulin to focus primarily on how much insulin is needed to match the food they are eating and their physical activity levels. Although these skills are important to help people manage their diabetes, this approach can lead to the impression that they can eat and do whatever they want as long as they adjust their insulin accordingly.

Over time this approach often leads to people needing to take more and more insulin; which increases their risk of hypos, (further) insulin resistance, weight gain, and other health complications.

In other cases people make adjustments to their lifestyle to match their insulin dose and regimen. This approach reduces people’s freedom of choice and can therefore have a negative effect on their quality of life. It also means they will never be able to reduce their medication, but will likely need to increase their insulin dose as they become more and more resistant to the insulin they’re taking!

A different approach

Most people with Type 2 diabetes still make their own insulin, but have developed insulin resistance. Almost all people with Type 2 diabetes who require insulin may be able to REDUCE their insulin doses or be able to OMIT insulin altogether by making some changes to their lifestyle.

Although they will always need to take some insulin as they do not produce their own, for many people with Type 1 diabetes it is possible to REDUCE insulin requirements by making some lifestyle alterations.

The focus of the X-PERT Insulin Programme is therefore on helping people to make appropriate lifestyle changes that are acceptable and suitable for them. This can help them to reduce their insulin requirements. Making good lifestyle choices should come first, with insulin being adjusted accordingly; not the other way round!

What are the benefits of reducing insulin requirements?

There are a number of possible benefits to reducing insulin requirements:

* Reducing insulin levels can reduce insulin resistance, which reduces the risk of long term complications (reducing insulin resistance also helps to reduce insulin requirements, as the insulin you do take or produce will work better!)

* Reducing insulin levels can improve weight management, as insulin promotes fat storage in the body (losing weight helps to reduce insulin requirements too, as excess fat storage can contribute to insulin resistance!)

* Reducing insulin will reduce hypo risk, which can improve quality of life

* Taking smaller amounts of insulin may be less painful, so reducing insulin requirements can reduce the discomfort associated with managing diabetes

* Reducing the frequency that insulin needs to be taken can reduce the inconvenience of managing diabetes, which again can help to improve quality of life

There is another important benefit of reducing the need for insulin, and other diabetes medications; and that is the reduced cost to, and strain on, the NHS. Medications to manage diabetes take up a huge chunk of the NHS prescribing budget, and this is an unsustainable position with the number of people with diabetes continuing to rise. Reducing the number of people on insulin, and the amount those on insulin need to take, can play a big part in securing the future of the health service.

How does X-PERT Insulin help people reduce insulin requirements?

As with all of the X-PERT Programmes the focus is on patient empowerment. Rather than trying to tell the participants what to do, the programme provides information on what options are available and how they may be beneficial. This gives the individual the knowledge and confidence they need to choose, and try out, what they think will work for them!

The programme covers a number of factors that might affect the participants’ insulin requirements, such as:

* What are they eating? For example, are they consuming carbohydrates to excess?
* How often are they eating? For example, are they having lots of snacks; which increases the amount of time during the day their body will require insulin (see figure 1)?
* Are they doing enough physical activity?
* Are they doing the right types of physical activity? (Different activities can have a different impact on blood glucose, and different people can respond in different ways to the same activities. One size doesn’t fit all!)
* Are they chronically stressed? (Stress increases blood glucose, which increases the need for insulin)
* Are they having enough, or good enough quality, sleep? (Insufficient high-quality sleep can affect the body in much the same way stress can)

For different people there will be different prime drivers of increased insulin requirements, and different solutions that are suitable to their likes and needs. This is why patient-centred education is essential to help individuals to:

1. Identify areas that are relevant and important to them
2. Choose solutions that fit in with their lifestyle and preferences that they are more likely to be able to sustain

Summary

For many people taking insulin to manage their diabetes their current lifestyle and regimen is not effective in preventing their health from getting progressively worse, and/or their insulin requirements from increasing over time. This is not good for the individual, nor is it sustainable for the NHS.
Changing the focus of education to prioritise healthy lifestyles and patient choice can reverse this pattern and help people be able to reduce their insulin requirement. For people who are taking insulin to manage Type 2 Diabetes it may even be possible to omit their insulin altogether! This approach can help improve the health and quality of life, in the short and long-term, for many of the millions of people who currently manage their diabetes with insulin.

The X-PERT Insulin programme is only available in certain areas, but the Patient Handbook is available to purchase from our website. If you have any questions about this programme please do not hesitate to contact us at admin@xperthealth.org.uk!

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