Diabetes Self-Management Blog

Insulin therapy is often resisted by people newly diagnosed with Type 2 diabetes because of fears of weight gain, low blood glucose (hypoglycemia), and a declining quality of life. But according to research recently published in the journal Diabetes Care, insulin-based treatment is safe, effective, and well tolerated in those newly diagnosed with Type 2 diabetes, and additionally it does not cause greater weight gain or more episodes of low blood glucose than oral diabetes treatments.

To evaluate the willingness of people newly diagnosed with Type 2 diabetes to take insulin and their quality of life while using it, researchers enrolled at 58 people ages 21–70 who had been diagnosed with Type 2 diabetes in the previous two months in a study. For the first three months of the study, all of the participants were prescribed a regimen of insulin and metformin (brand name Glucophage and others). At the three-month mark, half of the participants were randomly assigned to continue taking insulin and metformin while the other half were switched to a combination of the oral medicines metformin, pioglitazone (Actos), and glyburide (DiaBeta, Glynase, Micronase).

Twenty-four people in the insulin group and 21 people in the oral treatment group completed the three-year study. Of those assigned to the insulin-based treatment, 93% followed the prescribed therapy, while 90% in the oral drugs group adhered to taking the trio of prescribed medicines. Both regimens reduced the participants’ HbA1c (an indicator of blood glucose control over the previous 2–3 months) levels to roughly 6%.

Overall, 55 of the 58 original participants had at least one episode of low blood glucose. The researchers found that those taking the insulin and metformin combination experienced fewer episodes of hypoglycemia and had significantly less weight gain than those on the oral drug regimen. Those in the insulin treatment group also reported a high level of satisfaction with the insulin therapy.

According to lead study author Ildiko Lingvay, MD, MPH, MSc, “There is a myth out in the community…that insulin is the last resort and that somebody started on insulin is going to die. We as physicians are responsible for teaching the patient that that’s not the case.”

For more information, read “Physicians Bust Myths About Insulin” or see the study in Diabetes Care. And to learn more about insulin therapy for people with Type 2 diabetes, check out “Type 2 Diabetes and Insulin: Getting Started.”

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Comments
  1. What about the excess insulin acting as a carcinogen theory?

    Posted by Harry......................... |
  2. Why did I gain 14 lbs. within three months after starting insulin? I can’t find another reason, I,ve been closely monitoring my diet and exercising more, nothing helps!

    Posted by Peggy |
  3. If you are a type II diabetic that produces more insulin then can be absorbed into the cells, why would you increase the blood content of insulin which can cause serious side effects prematurely?

    Posted by Walter C Phillips |
  4. I chose to begin Insulin therapy after an initial trial of Metformin proved to be inadequate. I did a great deal of reading and concluded that the risks inherent in other oral medications were greater than the risks of insulin therapy. I have an A1c of 5.5 and had insignificant weight gain. I find insulin more flexible and whole heartedly agree that it should be presented as an option early.

    Posted by polly |
  5. I agree that sulphonyl ureas are worst than insulin because in comparaison they give you poor control and for the same level of BG can even cause more weight gain.

    It should be highlighted however that insulin is not a perfect therapy and you have to minimize the amount you use or weight gain will occur. Combining insulin with meformin (if you tolerate that drug) may be best for most people.

    Posted by CalgaryDiabetic |
  6. I have been a Type II diabetic for over 47 years and have progressed thru series treatments over the years. After years on oral treatments which were sometimes effective and sometimes not, I was then treated with Nph insulin and Avandia with satisfactory BG results. I am now using insulin glargine (Lantus) with excellent results and HBA1C”s in the 5.0 to 6.5 range. Very Close personal monitoring of my vblood Glucose has been very effective in my insulin therapy as Lantus is a 24 hour duration insulin. Works fo me!!

    Posted by Robert K. Hicks |
  7. My mum has been newly diagnosed as diabetic when she was admitted in hospital for Pneumonia. Her HBA1C was >11 and blood glucose level was around 13-14. She was prescribed with Insulin two times a day. She preferred oral medicine but the doctors did not do that. after 6 weeks her BSL is on control as fasting report is 90 and PP is 6.1mmol. (She still prefers oral medication cause she lives in a part of Asia where no Insulin Pen are available. my non- medical brother gives her with insulin syringe twice a day, which making his n her life hard.

    Now, with that normal BSL, Dr. has ordered Metformin. My mum is very happy on that. So,
    1.) Metformin alone will be good enough for her even after switching from Insulin?
    2.) Why he didn’t prescribed oral meds initially?

    She can be understandable if she should depend on insulin forever,but its just a question if she can be on oral meds as she is just newly diagnosed?

    Posted by shuv |
  8. There are some confusions here and mis understandings. As 30 year type 2 with extensive experience nearly rotting out on oral meds; I have major issue.

    a) I am today on metformin and Insulin both. I do not consider metformin in same class as glyburide.
    Being on Oral drugs means to me that one is taking starlix/glyburide.

    Metformin is to drop excess liver glucose release.
    Glyburide/starlix are used to boot pancreas insulin output.

    b) its a myth that oral drugs do not cause lows and reduced weight gain. I was desparately trying to get/keep weight down and diet and found starlix/glyburide huge pain in derriere.

    c) being on metformin and insulin shots has provided way better control and complementry operation with working pancreas. Liquid insulin shots are fully variable and allow way to better control with working pancreas. Starlix/glyburiude do not. In fact the 10.5 hour reach of glyburide was distinct pain forcing me to eat all the time.

    Lumping metformin in with glyburide as oral drugs class versus insulin is inappropriate and driven by mis-understandings.

    I take more metformin and is key to controlling my t2 while insulin provides a proper complementry boost to my pancreas and lows are not one of the problems that I was always having issues on starlix/glyburide.

    It needs to be pointed out that metformin slows the excess glucose release from liver at source while insulin acts afterwards to store the excess insulin present already put into blood system. In fact metformin can reduce the amount of insulin required as well as reduce the loading of the temporary glucose storage sites of the body’s skeletal muscle cells and fat cells and help prevent saturation causing insulin resistance.

    I admit having a cgms allows a wider opportunity and data to control tighter. Starlix/glyburide operation unpredictable on its insulin generation.

    Insulin properly used does not in my case add to weight gain.

    I am on a 1200 calorie diet plus one to two miles walking and my weight has dropped from 330 pounds to sub 240 pounds.

    We desperately need to get the myths and mis information out of circulation. a1c is 6.4

    Posted by jim snell |

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