Why Insulin Use Isn't Always Permanent for Type 2 Diabetes

Weight loss and exercise may reduce your need for insulin.(HEALTH/FOTOLIA)

If your doctor puts you on insulin, it's not necessarily permanent. Unlike people with type 1 diabetes, who need insulin to survive, people with type 2 diabetes use insulin as just one more tool to control blood sugar.

You may be able to go off insulin if you can get your blood sugar under control using diet and exercise.

"A person who is very, very obese or very heavy will find that if they lose a large amount of weight, their insulin requirements or their oral medication requirements may drop tremendously—even disappear," says Richard Hellman, MD, former president of the American Association of Clinical Endocrinologists.

Taking insulin just after diagnosis may also make it easier in the long term to control your blood sugar with diet and exercise, according William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta.

Glucose toxicity
"When the sugar has been running high it creates in and of itself a resistance to other things to bring it down. It's a term we call glucose toxicity," says Dr. Bornstein.

"So let's say that somebody comes in and their blood sugar is running pretty high and they want to try diet and exercise. It's less likely that the diet and exercise will work to bring it down.

"So we might use medication for a period of time, bring it down, then stop the medication and let that individual have a period of time to try diet and exercise and see if that'll work to keep it down," says Dr. Bornstein.

If you've developed diabetes recently and needed insulin right away, there's a better chance that you may be able to eventually reduce your dose or even stop taking insulin if you exercise and lose weight.

Diabetes is a progressive illness
Sometimes diabetes is diagnosed later in the disease—even a decade or more after its onset. If the insulin-producing beta cells in the pancreas are too far gone to salvage, you may need to take insulin permanently.

Similarly if you were exercising and were not overweight at diagnosis, you may get less traction from lifestyle changes and are more likely to need insulin in the long term.