When to Take Insulin for Type 2 Diabetes

If you have type 2 diabetes, you’re probably aware of how difficult it can be to manage. You may struggle keeping your A1c levels in line despite exercising, managing your weight, eating a healthy diet and taking a prescription medication.

Cause of Diabetes

Type 2 diabetes is caused by insulin resistance, stemming usually from genetics, aging, ethnic background, or being overweight. Insulin is a hormone secreted by the pancreas to maintain blood sugar levels. It does this by signaling the liver to store or release sugar into the blood and escorting sugar circulating in blood into cells so that it can be used as energy. 

Insulin resistance begins when cells won’t allow insulin to “unlock their door” to let sugar into it. Occasionally it doesn’t produce symptoms, but more often than not insulin resistance causes blood sugar levels to rise, leading to prediabetes. Between 15 and 30 percent of prediabetes cases will progress to type 2 diabetes within five years, according to the Centers for Disease Control and Prevention.

Treatments for Type 2 Diabetes

Type 2 diabetes patients are typically prescribed oral medications and lifestyle changes. Generally, insulin is only prescribed after these approaches have become ineffective, as insulin has been linked to weight gain and low blood sugar – although some physicians may use it earlier in treatment. 

“Most patients with type 2 diabetes need help absorbing sugar and responding to insulin – as opposed to patients with type 1 diabetes whose bodies do not make enough insulin -- and there are a wide range of medications that can help,” says Bernard Kaminetsky, MD, medical director, MDVIP. “But for a patient who’s lived with progressive type 2 diabetes for a decade or two, insulin may be the only effective treatment for them.”  

When to Take Insulin for Type 2 Diabetes

Your doctor may try combination therapy (insulin plus oral medication) or short-term therapy (insulin for a brief period) before prescribing long-term insulin because converting from oral medication to injectable insulin can be a little tricky. Regardless of the length of insulin therapy you’re prescribed, it’s important to understand the types of insulin available before you transition to it:

• Rapid-acting: takes effect within 15 minutes and should be taken before a meal.
• Short-acting: takes effect within 30 minutes and should be taken before a meal and should be taken in conjunction with a longer lasting insulin.
• Intermediate-acting: taken twice a day and lasts between 10 and 16 hours; used to help patients get through periods of fasting.
• Long-acting: taken once a day and lasts between 20 and 24 hours; you may need two doses of intermediate-acting insulin in addition to your daily long-acting dose.
• Pre-mixed: a combination of intermediate-acting; often used to help prevent blood sugar from rising in between meals. 

“You’ll also need to learn how to inject insulin. Proper injection techniques can make a big difference in insulin absorption rates,” says Kaminetsky. “Absorption can vary based injection site, frequency of injecting into a specific site and the amount of pressure applied while injecting.”

Before taking insulin, your physician will likely connect you with a diabetes educator for extensive training. Your dosage will be based on your needs and factors such as age, weight and activity level. And if you take insulin, you’ll need to test your blood sugar more regularly to track how well the insulin is controlling your levels. And it’s common to experience low blood sugar (hypoglycemia) until you get the hang of how much insulin you need throughout the day, so you'll want to speak to your doctor about how to treat low blood sugar in case your's drops below normal levels.

If you need help managing or preventing type 2 diabetes or prediabetes, work with your primary care doctor. They should be able to create a plan to help you manage blood sugar levels. Don’t have a primary care physician? Consider partnering with an MDVIP-affiliated physician. They have time to really work with you and develop a wellness plan that addresses issues like weight management, insulin resistance and diabetes. Find one near you and begin your partnership in health »