When Is Insulin Needed With Type 2 Diabetes?

Some people will require insulin injections in addition to lifestyle adjustments to help manage their blood sugar levels for type 2 diabetes.

Type 2 diabetes can occur at any time of life and is the most common form of the disease, according to the American Diabetes Association (ADA). It happens when your body can't properly produce or use insulin.

Insulin is the hormone produced by the pancreas that helps your body's cells take up glucose (sugar) so that it can be used for energy or stored to be used later. When your body doesn't make enough insulin or isn't using in the right way what is produced (known as insulin resistance), type 2 diabetes may ensue.

Type 2 diabetes can sometimes be treated and handled with lifestyle changes—like healthful eating, exercise, and stress management. But some people will also need oral medication or insulin injections to help treat the disease.

There's no simple way to tell when a patient with type 2 diabetes would do best on insulin, but there are guidelines, said Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists and managing partner of Hellman and Rosen Endocrine Associates in Missouri.

The guidelines are based on how much sugar is in your blood. To find out the percentage, an A1C test is performed. It measures your average blood sugar over the previous two to three months. This is not the same thing as testing your blood sugar with a finger stick, which tells you your current momentary blood sugar level.

When you and your healthcare provider have set a certain goal for your A1C and it's not being met using lifestyle changes and oral medications, insulin may be the next step. "In general if a patient has a hemoglobin A1C that is higher than the agreed-upon goal and they are not on insulin, we recommend insulin therapy," said Dr. Hellman.

Some of the primary governing agencies for diabetes management, including the ADA, the American Association of Clinical Endocrinologists (AACE), and the American College of Endocrinology (ACE), recommend an A1C of less than 6.5%. Diabetes is typically diagnosed with an A1C of 6.5% or higher, and a normal A1C is below 5.7%.

An A1C lower than 6.5% is the goal "as long as it can be achieved in a safe and affordable manner, but higher targets may be appropriate for certain individuals and may change for a given individual over time," according to the AACE and ACE.

The Goal of Insulin Is to Mimic the Pancreas

If you do need insulin, your healthcare provider may prescribe one of five primary types—rapid-acting, regular or short-acting, intermediate-acting, long-acting, or ultra long-acting. These vary in how quickly or slowly they reach the bloodstream (the onset), the amount of time they work at maximum strength (the peak time), and how long they continue to be effective (the duration).

The different types of insulin work to mimic the natural rhythm of a healthy pancreas, which produces a consistently low level of insulin as well as occasional bursts to cope with post-meal surges in blood sugar.

You May Be More Likely to Need Insulin the Longer You Have Type 2 Diabetes

When you have type 2 diabetes, the beta cells in the pancreas churn out insulin as fast as they can to overcome the resistance your body has to the hormone (insulin resistance). This Herculean task can eventually exhaust the beta cells and diminish their ability to produce insulin. Sometimes they are unable to produce any insulin at all.

The good news is that early treatment to reduce blood sugar can help save the beta cells. Because diabetes is a progressive disease, if it is diagnosed a decade or more after its onset, the beta cells are sometimes too far gone to salvage. In this case, you may need to take insulin for the rest of your life.

Needing Insulin Does Not Mean Failure on Your Part

If your healthcare provider feels you need to take insulin to help control your diabetes, it does not mean that you've failed in some way. Some bodies simply require more help with controlling the condition. And sometimes insulin is the bridge you need to help level out your blood sugar so that you have the energy to make the lifestyle changes you need to make. Once you make those adjustments and your body is responding to them, you may be able to go off the insulin (as long as the lifestyle changes continue).

As with any major change, you may feel stressed and disappointed. And if you feel ashamed—as if you've failed with your health or let your family down—the stress can compound. According to the Centers for Disease Control and Prevention (CDC), these feelings are common. It's important to take care of not only your diabetes but also your mental health because people with diabetes are two to three times more likely to have depression compared to people who do not have diabetes, the CDC says.

This may develop if you begin to feel as if your diabetes is controlling your life, creating a state called "diabetes distress." According to the CDC, these feelings can cause you to neglect health habits, blood sugar monitoring, and appointments with your healthcare provider. The condition is so common, the CDC says, that "in any 18-month period, 33% to 50% of people with diabetes will experience diabetes distress."

Even people who have had years of healthy diabetes management can fall into this mindset. That's why it's important to recognize when you're feeling down and stressed and talk to your healthcare provider, who may recommend seeing a counselor. If your stress is due to a lack of knowledge or confidence in how to manage the condition, a diabetes educator may help.

Whether you need insulin or not, type 2 diabetes management requires behavioral changes for optimal health. From healthy eating and exercise to managing your stress and getting enough quality sleep, these changes will go a long way in helping your body manage the condition.

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