In 1923, Dr. Elliott Joslin said, “Insulin is a remedy primarily for the wise and not for the foolish, be they patients or doctors. Everyone knows it requires brains to live long with diabetes, but to use insulin successfully requires more than brains.”

Diabetes is a hard disease to understand for both patients and doctors. Too often, we boil it down to insulin, or the lack thereof, but there is so much more to it than that. Even if you are very careful with what you eat and are right on top of your insulin therapy, good A1C control can be difficult to maintain. That’s something that even medical professionals have a hard time understanding, partly because we’re just beginning to grasp all that goes into internal glucose control.

It can be hard for a general practitioner to keep up. Recently, during a lecture to physicians, I put the following multiple-choice question on the screen:

What is the hormone that is co-secreted from the beta cell in equal concentrations as insulin?
a) Amylin
b) Glucagon
c) Somatostatin
d) GLP-1
e) Islet Ghrelin

Don’t feel bad if you don’t know which to choose. In a room of some 50 physicians, none gave the correct answer of amylin.

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