When the insulin therapy starts depends, e.g. on the patient’s overall condition, sugar balance targets, blood sugar level, weight trend, duration of condition, other medical conditions and ability to function as well as whether the type of diabetes includes insulin deficiency or insulin resistance.
However, if the person is obese, the management of blood sugar should primarily be boosted by a GLP-1 product instead of insulin. Other effective means of treating overweight, exercise and diet guidance should aksi be offered before starting insulin therapy.
Temporary insulin therapy
If the blood sugar level is very high at the time of diagnosis, it is not instantly possible to determine the type of diabetes. In this case, the management of diabetes can start with insulin therapy. Once the situation has become stable, it is time to establish the degree of insulin deficiency and think about further treatments.
Insulin therapy may also be temporarily required during serious inflammatory diseases when it is normally not possible to keep the blood sugar level within the target range using other treatments. Insulin therapy is also used during major operations. Orally taken cortisone may also increase the blood sugar level to a degree that it becomes necessary to take insulin temporarily.
More permanent insulin therapy
It is recommendable to start insulin therapy, if the blood sugar management targets cannot be reached by means of intensified care guidance, diet and exercise therapy or other medicines. In most cases, this means an HbA1c level that is consistently over 53 mmol/mol or a fasting sugar level that is consistently over 7–8 mmol/l. Initially, the treatment comprises one basal insulin injection per day combined with other medicines.
In many type 2 diabetes cases, the failure of the insulin-producing pancreatic beta cells progresses gradually. Sometimes earlier, but in most cases after 20–30 years of living with diabetes, the management typically requires basal insulin in addition to other treatments. In some cases, MDI (Multiple Daily Injections) therapy is necessary, where in addition to basal insulin a rapid acting insulin is taken with meals.
It is not unusual that, after an initial type 2 diabetes diagnosis, it turns out over the time that it is actually a slowly progressing type 1 diabetes. Insulin deficiency can be diagnosed with a C-peptide blood test.