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Starting insulin therapy in type 2 diabetes

The decision to start insulin therapy is always individual and something to be agreed upon together. Insulin treatment may be needed temporarily or on a permanent basis.

In addition to blood sugar levels, the decision to start insulin therapy is influenced by the nature of diabetes, the duration of the illness, and the individual's functional capacity. A transition to insulin treatment should be made if the blood sugar treatment targets are not achieved with intensified care guidance, dietary and exercise therapy, and other medications. For most, this means a consistently high HbA1c level over 53 mmol/mol or fasting sugar consistently over 7–8 mmol/l.

For an overweight person with type 2 diabetes, blood sugar treatment should primarily be intensified with a GLP-1 preparation, not insulin. Other effective obesity treatments, as well as exercise and dietary guidance, should also be available before starting insulin treatment and during its course.

When transitioning to insulin treatment is necessary, one should not delay the initiation of injection therapy. Many think that insulin treatment is the "last resort" and requires more meticulous dietary monitoring than before. This can lead to unnecessary delays in starting insulin treatment. Improved blood sugar levels with insulin treatment usually significantly improve well-being, and other self-management is easier than before.

Treatment with modern injection tools is technically easy and almost painless. Support and adequate guidance from one's own nurse are essential in the early stages of treatment. The individual should also have the possibility to easily contact their nurse or doctor if there are questions or problems regarding the treatment.

Most of those with type 2 diabetes who need insulin treatment achieve treatment goals using a combination of long-acting basal insulin and oral medication or GLP injections.

Updated 25.10.2023