If I Have Type 2 Diabetes, Will I Eventually Have to Take Insulin?

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People with type 2 diabetes can be treated with many different regiments from just lifestyle alone if they are diagnosed early, to going on regiment that we use for people with type 1 diabetes multiple daily injections or an insulin pump. So it is part of the continuum and I like to call that the natural history of type 2 diabetes, because we know that over time it doesn't occur to everybody, but for the majority of people they will need more medications to keep their blood sugars under control.

Typically as lifestyle or medications one, two, three sometimes four different oral medications they might need the pills during the day and at shot of long administered insulin at night, then they may need multiple daily injections, they may eventually need a pump and that typically occurs over time.

And the main difference over time is that people with type 2 diabetes can secrete insulin unlike type 1 in the beginning and over time they lose that ability, so the medications they are taking become less effective. And that's a big psychological thing for patients too because their care giver is telling them they need more medication and you know how all of us are, we don't want to take prescription medication so they think, oh my gosh, now I need insulin.

And that's a big stumbling block for a lot of people with type 2 and at least for years and years of probably to control the diabetes, because they don't want to go on that, the shot, the needle, and the care giver is trying to talk them into it. So it comes down to education once again these little needles, we can hardly feel them and that insulin is a natural substance.

Everybody on this earth needs insulin whether it comes from our own pancreas or they inject it and so not every individual type 2 will go on insulin but many will need to do that so that they can control the diabetes. For people with type 2 diabetes and they go through the natural history of type 2 it can be pretty frustrating because they are doing everything right.

They're following a diet, they're exercising things haven't changed at all but yet their blood sugars may be creeping up and part of the challenge really is educating those folks about insulin and that it's a natural hormone and I give them the 30-day challenge, I say that let's start insulin, and if it hurts too much, if your blood sugars don't come down or if you just don't like, we'll stop it.

And I have never had a patient, I know you are not supposed to say never but I have never had a patient who I have successfully titrated the dose appropriately over the month, say I don't want it anymore. So it's really an emotional barrier of what they say to themselves is oh my God! If I go on insulin I'll be on it for rest of my life.

And that's why when I say to them they'll stop, because they won't, severely be compensated, and they like that. Now, I know that once they start it they'll probably for the rest of their life, and that's not a big deal. The other thing I want to say is we have a lot of advances in type 2 diabetes we have new oral medications, we have a whole class called the [UNKNOWN] which are a whole class agents that actually lower the blood sugar, they help with weight, they do not cost low blood sugar as part of the side effects and I believe with the advent of these new drugs that people will delay the need for insulin, not that that's so cannibal[sp?] to go on insulin but if you don't need it, then why not.