“Does using insulin mean that your diabetes is at its worst?”

Not necessarily. This just means that your doctor feels that insulin is the better treatment for you at this time. If you are a type 1 diabetic, you will need insulin from the very start of your treatment to bring down the blood sugar. Because you don’t make your own natural insulin hormone, you will still need to continue injecting insulin even when the blood sugars are already in the normal range.

If you have type 2 diabetes, your pancreas produces its own insulin but other organs cannot properly use the insulin to bring down the blood sugar. Because you actually make insulin, treatment is proper nutrition, weight loss and physical exercise. Your doctor may also start you on tablets to make the body more sensitive to the insulin from the pancreas. When diet, exercise, and medications still do not achieve optimal blood sugar levels, then it may be time to shift to insulin therapy. The longer a person has had diabetes, the more likely they will have to start insulin treatment at some point.

There are certain circumstances when it may be necessary to give insulin temporarily to type 2 diabetes patients. This happens when there is a relative lack of insulin being produced by the pancreas, when you cannot take tablets or when there is a need to bring down the blood sugar immediately. Your insulin needs are increased temporarily when you have a severe infection or are acutely ill in the hospital.

Tablets take time to work and the severity of the illness contributes to the high sugar. Insulin given in small doses can stop this vicious cycle and control blood sugar fast. Giving insulin at the same time the infection is being treated can shorten the course of the disease and prevent repeated infections.

Heart attacks, strokes and other critical illnesses are more common in diabetics. Better blood sugar control can help with patient recovery and shorten hospital stay. When the infection or illness resolves, your doctor will let you know when you can safely resume oral medications.

You may also need insulin when you cannot take tablets as in pregnancy, or during surgery. Near normal blood sugars during surgery promote wound healing and prevent infections. Even if some diabetic medications have already been found to be safe for use in pregnancy, insulin is still the fastest and most effective means of controlling the blood sugar in the mother and preventing complications in the baby. After delivery, most mothers are advised to resume the tablets they were taking before the pregnancy.

When your diabetes is already complicated by eye, kidney or nerve damage, then bringing down the blood sugar to near normal levels is more effectively achieved by insulin. Further, hyperglycemia tends to worsen these complications. Most diabetes drugs pass through the liver or the kidney. If you have liver or kidney problems, your doctor may opt to stop medications that go through these organs and give small doses of insulin to prevent blood sugar fluctuations.

Then of course, there are cases when tablets just don’t work. Severe weight loss, excessive thirst, frequent urination and blurring of vision indicate that your current treatment is not controlling your blood sugar. Your pancreas has been bombarded by high blood sugars for some time, and your own insulin is vanishing. You’re out of insulin! Using tablets that work by trying to increase the body’s insulin production are useless at this time. Treatment with insulin will effectively bring down the blood glucose levels, relieve your symptoms and give your pancreas a break.

Short, intensive courses of insulin may slow down the progression of diabetes. Your doctor can help you adjust your insulin dose, giving more if the blood sugars remain high, and giving less if hypoglycemia (or low sugars) occurs. These low sugars may signify a return in the function of your pancreas. In such cases, patients can be slowly shifted back to tablets without a rebound increase in the blood sugar. With proper diet, exercise and maintenance of weight, the need for permanent replacement of your pancreas with insulin injections could take years to come.

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