By Wil Dubois

In the olden days, a few years ago, there were pills and there was insulin. That was it. If the pills didn’t control your diabetes, you had to go on the dreaded needle.

And even though insulin is a miracle drug, people hated it and would do almost anything to avoid starting it. Why? Well, there were lots of different theories, but it was long believed that it all boiled down to one simple fact: it’s un-natural to stick yourself with something sharp.

Then along came a lizard. Not that cute one from Geico, but an ugly poisonous one, the Gila Monster. Study of its spit led bio-medical researchers in a bold new direction, to a medication that would launch a three-pronged attack on elevated blood sugar. It would slow gastric emptying, hold back the liver’s release of glucose when eating, and restore the feeling of satiety missing in many type 2s after they eat. Better still, it did all of this in a glucose-dependent manner, drastically reducing the risk of low blood sugar.

So, what’s not to love? Well, there was just one problem—it had to be injected. Many worried there was no market for the new med. People don’t like shots, was the common wisdom.

No doubt there was much Maalox in the boardrooms of the small startup Amylin and the giant Lilly, who together brought the novel new therapy, called a GLP-1, to market. But antacids weren’t in order. Champagne and caviar was, because seven years later, the GLP-1 category has skyrocketed to 20% of the type 2 drug market, and industry analysts project that GLP-1 meds will be nearly half of all diabetes drugs used by 2020. Today, there are three to choose from: the original twice-daily Byetta, the newer once-a-day Victoza, and the brand new once-weekly Bydureon. And the field is about to get a lot more crowded. Pharma giants GlaxoSmithKline, Lilly, and Sanofi all have GLP-1s in the pipeline.

How on earth did that happen? Aren’t people supposed to be afraid of needles? As it turns out, people weren’t afraid of needles. They were afraid of insulin because it has a bad reputation.

For many years, American doctors used insulin as a negative re-enforcement tool. Lose weight or I’ll have to put you on insulin! Insulin “starts” were delayed too long. Complications set in. Insulin was unjustly blamed for the damage caused by out-of-control diabetes. It turns out that fear of needles was the excuse offered to cover fear of insulin.

Needles, the stated barrier to insulin, suddenly weren’t a factor for most people when offered the new GLP-1 meds. Oh… and I suppose that one of GLP-1’s side effects might have had a role to play in its quick acceptance.... people tend to lose a lot of weight on the drugs. Funny how something like that suddenly makes a needle a non-issue.

The future, for type 2s, will be needles sans insulin.