Ask The Expert
Insulin

When you started insulin 10 years ago, there was only one category of oral agents available (sulfonylureas) which stimulates the pancreas to produce more insulin. Now we have so many more choices, with drugs in 6 different categories.

Keep in mind that type 2 diabetes is a progressive disease, and over time, many people will require insulin. In other words, the oral agents work for a while, but eventually, the pancreas just doesn't produce adequate amounts of insulin, and many people with type 2 may need to take insulin for the rest of their life.

It is possible you may be able to get off insulin

Of course, each person is different. I have seen people who were overweight when they started insulin (because the oral agents weren't able to adequately control their diabetes). Several years later, after they followed a careful diet and exercise regimen and lost their weight, they were able to go off insulin. In these cases, their initial need for insulin was due to insulin resistance caused by the excess weight; so the weight loss and exercise reversed the insulin resistance, and they no longer required injected insulin to manage their diabetes. Needless to say, you must first discuss this thoroughly with your doctor.

You may still require insulin

However, there are also many people who lost all their excess weight and adhered to a careful diet and exercise plan, yet despite all their success in lifestyle management, they still had elevated blood sugars and continued to require insulin, due to the basic fact mentioned earlier-that diabetes progresses over time.

New variables, new medications

What is different now is that not only are there more categories of oral agents, but also there are two newer categories of drugs, called incretin mimetics and DPP-4 inhibitors, that target specific problem areas in type 2 diabetes. Please be sure to read all the related questions to learn about the various options to consider.