People who are newly diagnosed with type 2 diabetes are usually treated with a combination of diet, exercise, and an oral medication (eg, pills). Some oral medications, such as metformin help insulin that is available in the body to work better. Other medications push the body to make more insulin. READ MORE ON ORAL MEDICATIONS FOR TYPE 2 DIABETES.
Usually, if blood sugars are not controlled within the first 3 months on the initial medication, a second medication may be added to the first, and then maybe a third or fourth medication– whatever it takes to help the patient achieve the goal HbA1c, usually <7%. Type 2 diabetes typically progresses over time, causing the body to produce less insulin and the body responds less to the insulin that is produced, as well. This is not the patient’s fault. It doesn’t mean the patient is doing something wrong. This is simply the way diabetes behaves, which means that many times doctors need to add more medications, or switch medications as time goes on. Of course diet and exercise can do wonders as far as how much and how many medications need to be added.
Oral medication plus insulin
Adding insulin is simply adding another medication. Most people become frightened, and even think that insulin leads to complications. But it is simply another medication that, unfortunately, needs to be given as a shot, instead of as a pill. Using a combination of treatments (oral medication plus insulin) often means that the person can take a lower dose of insulin, compared to insulin treatment used alone. There may also be a reduced risk of weight gain if combination therapy is used.
Insulin is generally given once per day, either in the morning or at bedtime. Usually the doses start small (since it is difficult to know what the requirement will be at first), but the dose is gradually increased to the correct dose, the dose that will keep the blood sugar level in the normal range. The only way to determine this is through frequent blood sugar testing.
READ MORE ON MONITORING BLOOD SUGARS
Most people with type 2 diabetes who start insulin, do so on top of another oral medication, such as metformin. However, there are instances when type 2 diabetic patients are treated only with insulin. People taking insulin alone often require two injections of intermediate-acting insulin or one injection of long-acting insulin per day.
If a long-acting insulin or a twice daily injection of intermediate-acting insulin is not adequate to control blood sugar levels, a more intensive insulin treatment regimen may be recommended, such as is used in type 1 diabetic patients. Intensive insulin treatment requires at least two injections of insulin per day, usually including a rapid-acting and long-acting insulin, or very rarely use of an insulin pump. It also requires that the person monitor their blood sugar levels several times per day. SEE TREATMENT FOR TYPE 1 DIABETES.
Types of insulin
There are several types of insulin and they are classified according to how quickly they begin to work:
- Rapid-acting (insulin lispro (Humalog®), insulin aspart (Novolog®), and insulin glulisine (Apidra®))
- Short-acting (eg, insulin regular)
- Intermediate-acting (eg, insulin NPH)
- Long-acting (eg, insulin glargine (Lantus®), insulin detemir (Levemir®))
The various types of insulin can be used in combination to achieve around-the-clock blood sugar control.