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Your options

  • Take insulin to keep blood sugar levels under control.
  • Don't take insulin. Try other methods to keep blood sugar levels under control.

Key points to remember

  • The goal in treating type 2 diabetes is to keep blood sugar under control. When you control your blood sugar, you decrease your risk for other health problems caused by diabetes, such as eye problems, kidney disease, and nerve damage.
  • Losing weight and increasing activity, along with taking pills (such as metformin), may be enough to keep blood sugar under control. Controlling blood sugar means staying in your target range.
  • If your disease gets worse and your blood sugar can't be controlled, your doctor will likely suggest that you take insulin.
  • Insulin is the most effective medicine for lowering blood sugar levels to meet target ranges and A1c goals.
  • If you decide to take insulin, you'll learn how to give yourself shots. And you'll need to know the signs of low blood sugar and what to do if you have a low blood sugar emergency.
  • Starting insulin doesn't mean that you've failed to control diabetes. Type 2 diabetes is often a disease that gets worse over time. Insulin can help people with type 2 diabetes keep their blood sugar under control.

How is type 2 diabetes treated?

The goal in treating type 2 diabetes is to control blood sugar levels by keeping them in your target range. Lifestyle changes, such as losing weight and being more active, are the first steps to get blood sugar under control. But you may also need to take diabetes pills (such as metformin), which help decrease the body's resistance to insulin and help insulin work better in the body.

Diabetes often gets worse over time. And when it does, diabetes pills don't work as well. Insulin can help people with type 2 diabetes keep their blood sugar under control. Sometimes your doctor may recommend insulin injections because of other health problems, such as kidney complications.

What is insulin?

Insulin is a hormone that helps sugar enter your cells, where your body uses it for fuel. When your body doesn't make enough insulin or can't use it the way it's supposed to, your blood sugar gets too high. This can be serious or even life-threatening.

How is insulin used?

Most people use insulin as an injection, or shot. It is given into the fatty tissue just under the skin. Learning how to give yourself insulin may take some time. You'll also need to pay more attention to your blood sugar levels than you may be used to. But with practice, monitoring your levels and using insulin correctly can become a routine part of your day.

What are the risks of using insulin?

Using insulin has few risks and side effects. You may gain weight, especially if you are already overweight. The biggest risk of insulin use is very low blood sugar (hypoglycemia), which can turn into an emergency if not managed right away.

About low blood sugar

Some common reasons for very low blood sugar include:

  • Taking too much insulin.
  • Skipping meals or not eating enough food.
  • Exercising without eating enough, or being much more active than usual.
  • Drinking too much alcohol (especially on an empty stomach).

By checking your blood sugar levels often, taking insulin on a schedule, and eating regular meals, you can avoid low blood sugar.

It's a good idea to know the signs of low blood sugar, which include feeling tired, weak, or shaky. If your blood sugar drops very low and you don't get help, you could get confused or drowsy or even lose consciousness and possibly die.

Most of the time, you can treat mild—and sometimes moderate—low blood sugar by eating something that contains sugar.

What are the benefits of using insulin?

Insulin is the most effective medicine for lowering blood sugar levels. Keeping blood sugar under control reduces your risk for other health problems caused by diabetes, such as eye problems, kidney disease, and nerve damage.

Why might your doctor recommend taking insulin?

If your blood sugar can't be controlled even if you lose weight and take oral medicines, your doctor is likely to recommend taking insulin.

Take insulin Take insulin

What is usually involved?

  • You give yourself insulin 1 to 4 times a day. Most people do this by giving themselves an injection, or shot.
  • You check your blood sugar levels several times a day to make sure that your levels are in your target range.
  • You stay at a healthy weight and get regular exercise.
  • You know the signs of low blood sugar, how to avoid low blood sugar, and what to do in case of a low blood sugar emergency.

What are the benefits?

  • Insulin is the most effective medicine for lowering blood sugar levels.
  • Keeping blood sugar under control decreases your risk for health problems caused by diabetes. These problems include eye problems, kidney disease, and nerve damage.

What are the risks and side effects?

  • Taking insulin increases your risk of very low blood sugar, which can be life-threatening if not managed right away.
  • You may gain weight if you take insulin.
Don't take insulin Don't take insulin

What is usually involved?

  • You check your blood sugar to make sure that your levels are in your target range.
  • You try losing weight and being more active to control your blood sugar.
  • You take diabetes pills to decrease your body's resistance to insulin. Or if you are already taking diabetes pills, you may need to increase your dose.

What are the benefits?

  • You don't have to give yourself a shot.
  • You don't have to worry as much about low blood sugar emergencies that can happen if you take insulin.

What are the risks and side effects?

  • If your diabetes gets worse, you may not be able to control your blood sugar.
  • You may gain weight while taking some diabetes pills.
  • You are at risk for high blood sugar emergencies, which can be life-threatening.
  • Uncontrolled blood sugar raises your risk for health problems such as eye problems, nerve damage, and kidney disease.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to take insulin

Reasons not to take insulin

I'd rather start insulin now than wait until my diabetes gets worse.

I want to avoid taking insulin as long as I can.

More important Equally important More important

I can't control my blood sugar.

I think I can control my blood sugar without insulin.

More important Equally important More important

I want to avoid other health problems from high blood sugar.

I'm less concerned about other health problems than I am about taking insulin.

More important Equally important More important

I don't mind giving myself shots.

I don't want to give myself shots.

More important Equally important More important

Gaining weight from taking insulin doesn't concern me.

I'm worried about gaining weight.

More important Equally important More important

My other important reasons:

My other important reasons:

More important Equally important More important

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Taking insulin

NOT taking insulin

Leaning toward Undecided Leaning toward

Check the facts

The goal in treating my type 2 diabetes is to avoid taking insulin.

  • True Sorry, that's not right. The goal in treating type 2 diabetes is to keep blood sugar under control.
  • False You're right. The goal in treating type 2 diabetes is to keep blood sugar under control.
  • I'm not sure It may help to go back and read "Get the Facts." The goal in treating type 2 diabetes is to keep blood sugar under control.

Insulin is an effective medicine for lowering my blood sugar levels.

  • True You're right. Insulin lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, blood sugar gets too high.
  • False Sorry, that's not right. Insulin lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, blood sugar gets too high.
  • I'm not sure It may help to go back and read "Get the Facts." Insulin lets sugar (glucose) in the blood enter cells, where it is used for energy. Without insulin, blood sugar gets too high.

Losing weight and increasing activity, along with taking pills (such as metformin), may be enough to keep my blood sugar under control.

  • True You're right. Some people may be able to control blood sugar by taking pills, losing weight, and increasing activity. Controlling blood sugar means staying in your target range.
  • False Sorry, that's not right. Some people may be able to control blood sugar by taking pills, losing weight, and increasing activity. Controlling blood sugar means staying in your target range.
  • I'm not sure Sorry, that's not right. It may help to go back and read "Get the Facts." Some people may be able to control blood sugar by taking pills, losing weight, and increasing activity. Controlling blood sugar means staying in your target range.

Decide what's next

Do you understand the options available to you?

Are you clear about which benefits and side effects matter most to you?

Do you have enough support and advice from others to make a choice?

Certainty

How sure do you feel right now about your decision?

Not sure at all Somewhat sure Very sure

Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

Use the following space to list questions, concerns, and next steps.

Personal stories about considering insulin

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My mom had diabetes. She had to give herself insulin shots, and it looked so messy and painful. I swore that it would never happen to me. Well, for 8 years now I've had type 2 diabetes. I feel like I've done everything I can at this point. I don't really want to start insulin, but it's more important to me that I stay as healthy as I can. I know that insulin can help me.

Jeff, age 48

A few years ago my doctor said I had type 2 diabetes. But I didn't feel any different, so I didn't do anything. Then a few months ago, my doctor reminded me what could happen if we couldn't get my blood sugar under control. I got scared. So I've been eating better and checking my blood sugar, and so far, it's working. My numbers are holding. I'm going to keep it up and see what happens.

Maria, age 54

When I found out I had diabetes, I really got motivated. I started walking every day, tried eating better, and lost about 40 pounds. And I took diabetes pills. I was able to control my blood sugar for many years before it started creeping back up. Now I'm still pretty healthy, but my levels are out of control. Taking insulin is the next step.

Shannon, age 67

Take insulin? Not me. Not if I can help it. I'm going to lose some weight and exercise more. I've been keeping a blood sugar diary so I can track what makes it spike. I think I can beat this thing without insulin if I work really hard. I'm just not ready to take insulin now.

Mike, age 58


By: Healthwise Staff Last Revised: July 11, 2013
Medical Review: E. Gregory Thompson, MD - Internal Medicine
David C.W. Lau, MD, PhD, FRCPC - Endocrinology

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