Why You Should Start Insulin Early

Patient Expert
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If you take insulin soon after a doctor tells you that you’ve got type 2 diabetes, recent studies show that you can avoid the worst consequences of the disease. You can even drive your diabetes into remission and preserve the beta cell function of your pancreas that you otherwise could lose. When your beta cells don’t work well, it’s even harder to manage your diabetes.

While everyone who has type 1 diabetes has to take insulin, only one-fourth of people with type 2 diabetes do so far, usually after years of failure on oral diabetes drugs. After you have tried one of them after another, and your blood glucose is still too high, people may have to go on insulin, although usually with reluctance. You still hear people with diabetes telling you with pride, “I don’t have to take insulin.”

Using insulin is not a consequence

Even worse is that some doctors even use it as a threat, saying something like, “If you don’t shape up, I’m going to make you inject insulin.” But by that time most of the beta cells of your pancreas that store and release your own body’s insulin into the bloodstream have also failed.

Instead, taking insulin right after your diagnosis can stop the typical progression of diabetes from bad to worse. Research by a team of doctors at Toronto’s Mount Sinai Hospital suggests that when you take insulin for a short term soon after your diagnosis of type 2 diabetes, it can have long-term and very positive effects. The conventional wisdom has it all backwards, they say.

Led by Dr. Ravi Retnakaran, M.D., an endocrinologist at Mount Sinai’s Leadership Sinai Centre for Diabetes, the team demonstrated that when introduced early in the course of diabetes, treatment with short-term insulin therapy for two to three weeks can restore the body’s ability to make and use its own insulin.

Who benefits most

The treatment doesn’t work for everyone. People who at the start of their treatment with insulin who have lower fasting blood glucose levels are more likely to achieve remission of their diabetes than people with higher levels. But surprisingly, people who had a higher body-mass index were more likely to get remission. After one year about 46 percent of all of the people studied were still in remission and after two years the proportion was 42 percent.

“Traditionally, by the time the patient is prescribed insulin therapy to treat diabetes, it’s too late to reverse the disease process,” Dr. Retnakaran says. “When we treat patients temporarily with intensive insulin therapy for three weeks early in the course of disease, it is possible to improve the ability of the body to make and use its own insulin.”

He hopes that his group’s studies will encourage the medical community to use this new strategy "to potentially reverse type 2 diabetes in its early stages.”

If that were permanent, it would be huge news. But even a one or two year holiday from high blood glucose that intensive insulin therapy already offers would greatly improve the quality of life for many of us.

The ADA/EASD Position on Insulin

But the standard treatment recommendations are in flux. The American Diabetes Association and the European Association for the Study of Diabetes now recommend in their current position statement that doctors consider insulin as a part of the initial therapy for people with type 2 diabetes.

If you want to regain your health, taking insulin is the quickest way to get there. While a very low-carb diet can work wonders, some people find it difficult to give up the bread and sweets and others are still suspicious of the amount of fat you need to eat for energy. None of the oral diabetes drugs can bring your blood glucose level down to normal nearly as quickly as insulin can.

Your doctor will probably be pleased to hear your request to take insulin, especially if he or she has been nagging you to take it. The beta cells in your pancreas that have been working so hard ever since you got diabetes will also be happy, appreciating the break that taking insulin will give them.

When it comes to taking insulin, don’t save the best for last. This might work for eating dessert, but it doesn’t make sense for your health.

See more of my articles on how to manage diabetes: When Remission is Better Than a Cure for Diabetes
Is Diabetes Progressive?
Fear of Needles? Use This Device to Better Manage Diabetes
Your First 9 Steps Toward Managing Your Diabetes
Does Your Diabetes Diagnosis Scare You?