Type 2 diabetes is the most common type of diabetes, and the most important pathophysiological mechanisms are insulin resistance (i.e., the body is insensitive to insulin and requires more insulin than normal to control blood glucose) and relative insulin deficiency. In other words, People with type 2 diabetes also have some insulin in their bodies, but because of insulin resistance, the body needs more insulin to control blood glucose, so insulin production is relatively inadequate.
Misconceptions about insulin therapy
Insulin is an injectable class of medication used to treat diabetes. Many people think that once a person with diabetes starts taking insulin, they become dependent and have to take insulin for the rest of their lives.
This is a complete misconception and an instinctive avoidance of “injections” (rather than insulin) as a treatment.
Timing of insulin therapy for type 2 diabetes
In the early stages of type 2 diabetes, the pancreatic β-cells can still produce some insulin, and with insulin-promoting drugs, they can produce some more insulin to keep blood glucose well controlled. However, with the prolongation of the disease, the function of the pancreatic β-cells will gradually decline, and the secretion of insulin will decrease accordingly, and if the patient’s blood sugar is high, the ability of the pancreatic β-cells to secrete insulin will decline even faster.
When insulin decreases to a certain level, even powerful drugs cannot promote enough insulin production by the β-cells to control blood glucose, and blood glucose gets higher and higher, a condition called secondary failure of oral hypoglycemic drugs. At this point, the body itself cannot produce enough insulin, and exogenous insulin is needed to control blood glucose in order to continue to control blood glucose and prevent the development of chronic complications of diabetes.
So, for patients with type 2 diabetes who have secondary failure of oral medications, insulin injections are needed to control blood glucose.
Procedure of insulin therapy
Insulin therapy is an important tool for controlling high blood glucose. At some point, especially when the disease is long, insulin therapy may be the primary, or even necessary, measure to control blood glucose.
Types of insulin
There are many types of insulins, which can be classified as ultrashort-acting insulin, short-acting insulin, intermediate-acting insulin, long-acting insulin, and premixed insulin. People with type 2 diabetes should choose the right insulin for their treatment under the guidance of their doctor.
In general, when oral hypoglycemic agents fail secondary to a mild to moderate increase in blood glucose, long-acting insulin can be added once a day to the original oral medication. If the patient’s blood glucose is high, premixed insulin injections may be needed to control blood glucose, meaning that the patient is completely dependent on exogenous insulin for blood glucose control.
Self-management of insulin therapy
Insulin therapy involves more components than oral medications, such as drug selection, treatment regimen, injection device, injection technique, glucose meter, and actions taken based on glucose monitoring results. So, insulin therapy requires more collaboration between the provider and the patient and more self-management skills on the part of the patient.
After starting insulin therapy, health care providers should guide patients to adhere to dietary control and exercise and increase patient education and guidance. In addition, health care providers should encourage and guide patients to monitor blood glucose as well as adjust insulin doses appropriately based on monitoring results to control hyperglycemia and prevent the occurrence of hypoglycemia.
After starting insulin therapy, patients should receive targeted education on self-management skills related to insulin therapy, risk factors for hypoglycemia, symptoms, and self-help measures.
In summary, patients with type 2 diabetes control their blood glucose with oral medications in the early stages and require insulin injection therapy in the mid- to late-stage stages. Regardless of the medication a patient uses, the goal is to keep blood glucose well controlled and prevent the development and progression of chronic complications of diabetes.