Blood sugar control is one of the most important parts oftype 2 diabetes management.
Although you may be able to treat the condition with lifestyle changes, such as exercise and weight loss, and with oral medications at first, most people with type 2 diabetes eventually need to take insulin.
"There are two times to start insulin for type 2 diabetes," explained Alaleh Mazhari, DO, an assistant professor of endocrinology at Loyola University Heath System in Chicago.
"The first is any time blood sugar is significantly out of control and a patient has symptoms," said Dr. Mazhari. "In these cases, the need for insulin may be short-term. The second time is when type 2 diabetes has progressed over many years and the pancreas can no longer make enough insulin to respond to other diabetes medications."
Here's what you need to know about taking insulin in both scenarios.

Insulin for Short-Term Blood Sugar Control

Doctors use a blood test called a hemoglobin A1C test to measure average blood sugar control over a two- to three-month period. The A1C measures the amount of sugar in red blood cells.
The treatment target for most people with diabetes is an A1C of 7 percent or less; those with higher levels may need a more intensive medication plan. "The American Association of Clinical Endocrinologists recommends starting a person with type 2 diabetes on insulin if their A1C is at or above 9 percent and they have symptoms," said Mazhari.
Research published in the journal The Lancet Diabetes & Endocrinology reviewed several studies on the temporary use of insulin to restore sugar control in people with type 2 diabetes. About two-thirds of the 559 patients studied were able to go off insulin and maintain good blood sugar control after a brief, three-month course of insulin.

Insulin for Long-Term Blood Sugar Control

"After 10 to 20 years, almost all patients with type 2 diabetes will need insulin," Mazhari said. "Once they lose most of the cells in the pancreas that make insulin, no other diabetes medication can help. They may have been on one, two, or three diabetes medications, but their A1C can no longer be kept in a safe range."
Switching from numerous diabetes medications to insulin can streamline your efforts.
"I always warn my patients that type 2 diabetes is a progressive disease and that treatment plans will change," said Harlene Pearlman, RN, a certified diabetes educator on the Loyola team. "When we can't meet blood sugar control goals despite our best efforts, insulin is the next step."
The change can have upsides. "Some patients have been on a complicated regimen of three or four medications, with lots of side effects," Pearlman said, "and it is actually a lot easier to be on insulin."

The Switch to Insulin

"Making the transition is much easier than it used to be," Pearlman noted. "Most patients are started on a long-acting insulin that does not need to be matched with food intake.
"Insulin pens that are preloaded are replacing insulin that needs to be drawn up into a syringe. Patients may still be worried about giving themselves injections, but once they see how tiny the needle is, they adjust quickly," Pearlman said.
The key to an easy transition is education. "Patients need to know how their insulin works, how to give it, and what side effects to look for," Mazhari said. "Most patients will be starting with one shot a day at bedtime. The dose will be adjusted over time depending on blood sugar readings."
Here are important insulin basics:
  • Your dosing schedule and insulin type will depend on how advanced your diabetes is, your weight, your age, your physical activity, and your diet. "There is no 'standard dose' for insulin," said Pearlman.
  • Work with your diabetes team to come up with a blood sugar testingschedule at home. You may be instructed to check your blood sugar three or four times per day during the adjustment period. Your health care team will use information about your fasting, pre-meal, and post-meal blood sugar levels to make changes to your insulin regimen.
  • Learn the symptoms of low blood sugar, or hypoglycemia, and what to do if you have them. The warning signs include feeling cold, shaky, dizzy, or confused. "The symptoms come on suddenly, and patients should know to drink a half-glass of juice, eat some hard candies, or chew some [glucose] tabs," Pearlman said.
  • During the transition, stay in close contact with your treatment team. People starting insulin are often advised to meet with their health care providers on a weekly basis until blood sugars stabilize and the appropriate insulin dose is determined.
"The goal of type 2 diabetes treatment is early blood sugar control to prevent complications and halt progression," said Mazhari. "Control trumps everything because you only have a limited window of opportunity. Once you have complications, the damage may not be reversible. That means using whatever medications it takes, including insulin."
Plus, don't forget that a healthy lifestyle is always part of the treatment plan. "Obesity increases insulin resistance, so maintaining a healthy weight with exercise and diet means less need for insulin and less problems with type 2 diabetes," Mazhari added.