The timing of intensive insulin therapy for patients with diabetes is determined by the type of diabetes, medical history, and the islet cells’ own secretion.
For patients with type I diabetes who do not have islet function themselves, lifelong insulin use is required.
For patients with newly diagnosed type II diabetes, after lifestyle and dietary interventions, glycosylated hemoglobin>9%,fasting blood>11.1mmol/L, insulin can be used to initiate therapy for 2-3 weeks. The early islet beta cells are only partially damaged, and the rest of the normal islet beta cells still have compensatory capacity. The high glucose state will inhibit islet cell secretion, and the use of insulin to lower glucose can restore some of the secretory function of the islet beta cells.
In patients with type II diabetes of short duration, short-acting insulin is injected for 1-3 months and remission is achieved before switching to glucose-lowering drugs. Re-evaluation after 3 months of general treatment allows further modification of the treatment plan based on glycemic control and islet function.
For long duration of disease, poor islet function, and ineffective oral hypoglycemic agents, long-term insulin therapy should be chosen.