Insulin for type 2 diabetes

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Insulin for type 2 diabetes

Many people with type 2 diabetes have to take insulin. Experts disagree about when people with type 2 diabetes should begin taking insulin.

• A few doctors believe that insulin should not be used to treat most people with type 2 diabetes, because these people produce insulin, are resistant to insulin, and insulin can cause weight gain. They believe that insulin does not get to the heart of the problem, which is not being able to use insulin effectively. But eventually many people with type 2 diabetes need to take insulin because over time their pancreas produces less and less. When the pancreas no longer produces enough insulin or stops producing it, insulin injections are needed.
• Most doctors believe that since insulin accomplishes the goal of lowering blood glucose levels, it is a viable treatment option for people with type 2 who have difficulty controlling their blood glucose levels through lifestyle changes and/or oral medicines.
• A growing number of doctors are using insulin as a first-line treatment, along with diet, for people with type 2 diabetes.

At what point should insulin be used?

If you have recently been diagnosed with type 2 diabetes, you may have received insulin because of very high blood sugar (over 400 mg/dL) and either signs of very high blood sugar (hyperosmolar state) or symptoms of mild high blood sugar (fatigue, increased thirst, and urination). This initial dose of insulin was probably used to quickly control your condition.

• Most doctors view insulin as a treatment option for people with type 2 diabetes who have not responded adequately to other methods of blood sugar control. They believe that because it is often a difficult lifestyle adjustment for people to learn to inject themselves with insulin and because the risk of low blood sugar episodes is greater, it is best to reserve insulin for when other, less difficult methods fail.
• Others believe that if you are able to achieve better blood sugar control with insulin than without it, you should consider it as a treatment for your diabetes.

Drawbacks to insulin use

• Injecting yourself with needles may be slightly uncomfortable. Although it can initially be difficult to do the injections, most people become accustomed to it.
• The need for injections from 1 to 4 times a day means having to carry supplies with you, finding places to do the injections, and remembering to do them at the appropriate time intervals.
• Insulin therapy can be expensive depending on your insurance coverage. The expense of insulin treatment includes the cost of supplies as well as the insulin itself.
• An overdose of insulin can be dangerous. Whereas people with type 2 diabetes who treat their condition with lifestyle changes usually only need to worry about high blood sugar, people on insulin also have to be aware of the signs of low blood sugar.
• Using intermediate- or long-acting insulin requires that you eat meals at the proper times and in the correct amounts to prevent low blood sugar or high blood sugar.

Credits

Last updated:	August 14, 2007
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC