What type of diabetes requires insulin injections?

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  A Toby Smithson , Nutrition & Dietetics, answered on behalf of Academy of Nutrition and Dietetics

  People with Type 1 diabetes always require insulin injections in order to control blood sugar readings because they make little or no insulin. Insulin is also prescribed for Type 2 diabetes when oral medications or other injectable meds are not controlling blood sugar levels adequately. Anyone taking insulin of any kind is at risk for hypoglycemia (low blood sugar). Taking insulin does not mean you have a “bad type” of diabetes. The purpose of using insulin is to get the best management of blood sugar readings as close to normal blood sugar readings as possible to help avoid complications from diabetes.

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  A Dr. Mehmet Oz, MD , Cardiology (Cardiovascular Disease), answered

  

  People with type 1 diabetes have to replace their body's production of insulin with injections of insulin. Type 1 diabetes which is usually diagnosed in childhood but may be diagnosed at any age, occurs when the pancreas makes no insulin because of an autoimmune assault on the insulin-producing cells.
  
  People with diabetes have high blood sugar either because their pancreas doesn't make enough insulin (that's type 1 diabetes) or because their muscles, fat, liver, and other cells close the door on insulin and don't allow it to deliver glucose to them (that's type 2 diabetes).

  

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  A Dr. Gerald Bernstein, MD , Endocrinology Diabetes & Metabolism, answered

  Type 1 diabetes is an autoimmune disease that results in destruction of the insulin producing cells. People with this type of diabetes must take insulin. Type 2 diabetes is a multimolecular disorder that causes 2 things (at least). First insulin secretion is inadequate. It may be the amount or the way it is secreted. Second most people with this type of diabetes also have a resistance to the insulin they do put out. So it's a double whammy. There are three factors that come into play that might determine the need for insulin: physical activity, dietary intake and age. A lot of exercise, a proper diet to control weight may minimize the amount of medication you need for many years but this is a progressive disorder and as you get older so does your ability to produce insulin. Sooner or later, even under the best of circumstances you will need insulin. Now, it may be of advantage to start insulin way before that time to keep your blood glucose normal which leads to a better quality of life and reduce risk for complications.

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  A Amy Campbell , Endocrinology Diabetes & Metabolism, answered

  Actually, all types of diabetes (type 1, type 2 and gestational) can require insulin injections. With type 1 diabetes, a person's beta cells stop producing insulin (or enough insulin), so this means that in order to survive, insulin injections are necessary. In the case of type 2 diabetes, a combination of meal planning, weight loss, physical activity and oral medication may work well for a while to control blood glucose. But over time, at least 40% of these folks will need to go on insulin. And with gestational diabetes, insulin may be needed if blood glucose goals can't be met with meal planning and exercise alone.

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  A William Lee Dubois , Endocrinology Diabetes & Metabolism, answered

  The truth is we all take insulin. Every man, woman, child, chimpanzee, sea otter, and even fish. Insulin is a fundamental element that all critters on the planet share. Insulin the hormone that allows sugar to get from the blood into cells. An analogy that is often given is to picture every cell in your body as a little house with a locked door. Insulin is the key that opens the door so the pizza delivery guy can get it.

  So in non-diabetic folks, when the cell orders a pizza the pancreas sends out the delivery guy with a set of keys for the cell’s front door. (Just set aside for the moment the notion of the pizza guy having keys to your house is a more than a little bit creepy.) The delivery guy arrives at the cell’s door step, unlocks the door, and delivers the pizza.

  Now in Type-1 Diabetics, like myself, our immune system has killed off all of the cells in the pancreas that make insulin. So we’ve got a pizza chain with no drivers. Quite literally, we die if we do not inject. I guess you could compare injections to the pizza chain resorting to calling up a Temp Service and hiring some drivers for the day.

  Type-2 Diabetes is a bit different. Lots and lots and lots of drivers, but they are morons and keep leaving the pizza shop with the wrong keys. They can’t open the doors at the cells, the cells are getting hungry and angry and are calling the pancreas and saying “hey, we ordered a pizza an hour ago and the #@$% driver hasn’t shown up yet!” And the pancreas is like, hey, we sent the guy out… we don’t know what happened, but we’ll send another driver pronto.

  What’s happening in T-2s is called insulin resistance. For a time, the body makes lots and lots of insulin, but it just doesn’t work very well. To fight this resistance the body over produces insulin and eventually all of this overwork burns out the pancreas. In fact, as long as the body can keep up, most people are clueless that they have diabetes. It’s been estimated that by the time of diagnosis most T-2s only have about 10% of their insulin production capacity left. By 14 years post-diagnosis, it may be effectively gone. Once it is gone, it needs to be replaced to keep sugar levels safe. And that means injections. Bottom line: most diabetics will eventually need insulin. It is the nature of the disease, not a failure on the part of the person.

  Last note: women with gestational diabetes will often be given insulin for the simple fact that as a natural hormone, it is safe for her baby for her to take it.

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