Yes, some people with type 2 diabetes can manage the disease with diet, exercise, and oral medications alone. But if you need insulin to manage your blood sugar, it doesn't mean you've somehow "failed" in your effort to control diabetes.
You may need insulin right after diagnosis to quickly lower blood sugar, or you may need to start taking it with time because your diabetes has progressed (more of the naturally occurring insulin-producing cells have been damaged).
Either way, insulin gets the job done quickly and ultimately lowers the risk of complications. Plus there are many different types of insulin, from once-a-day injections to those taken before meals.
"When patients blame themselves for being on insulin, I tell them that self-blame is not fair to themselves and is actually distracting," says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists. "It is better to look at starting on insulin as a positive in the sense that insulin is a powerful tool that allows us to protect them against the complications of diabetes very well."
Insulin may prevent or delay diabetes damage
Doctors should be treating type 2 diabetes aggressively from the day of diagnosis, Dr. Hellman says, and if that includes drugs, so be it.
"I think we do diabetes care backwards," he reflects. "As a specialist I often see people doing the least they can do to interfere with their lifestyle, and then the problem progresses."
Yet the scientific literature suggests the better approach would be to get very good control of a person's blood sugar, blood pressure, and cholesterol from the start.
"If we did it the other way, I wonder if we could reduce the burden of this disease and put people like me out on the street," Dr. Hellman says.
And there's good news. New types of insulin require fewer injections than in the past, using smaller needles.
Unlike people with type 1 diabetes, who need insulin shots to survive, people with type 2 can sometimes stop taking insulin if they make major changes in their lifestyle (such as boosting exercise and shedding excess pounds).