When Is Insulin Needed With Type 2 Diabetes?

Type 2 diabetes happens when your body is not producing or using insulin properly. Unlike type 1 diabetes—which is a genetic condition and appears early in life—type 2 diabetes can occur at any time in a person's life. It is the most common form of the disease, according to the American Diabetes Association (ADA), and is often seen as a lifestyle disease.

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.

When Insulin Is Needed

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. The test 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.

A1C Blood Test

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, include the ADA, the American Association of Clinical Endocrinologists (AACE), and the American College of Endocrinology (ACE). These groups 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 of insulin available depending on your body's metabolism—rapid-acting, regular or short-acting, intermediate-acting, long-acting, or ultra-long-acting. These different insulin types will vary in the following aspects:

• How quickly or slowly they reach the bloodstream—known as the onset
• The amount of time they work at maximum strength—called the peak time
• How long the insulin continues to be effective—known as 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.

The Need for Insulin

Your doctor may be more likely to prescribe insulin the longer you have had type 2. 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. This is known as insulin resistance. This Herculean task can eventually exhaust the pancreas' 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 to save these beta cells. There are simple steps that you can take to reduce blood sugar, like walking after every meal. 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." The CDC says 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.