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Insulin for type 2 diabetes: when is it time to start?

Over 500 million people across the globe live with type 2 diabetes. Many will see their condition progress over time and may eventually rely on insulin to help manage their blood sugar.1,2 If you’re reading this article, your doctor may have told you it could be time to start insulin – and it’s natural to have some questions.

In fact, many people feel uncertain before taking this next step and may have reasons to put off getting started.3,4,5 For example, they may have worries about hypoglycaemia, injections, or gaining weight.6,7 They might be worried about what others will think.6,7 Or they may think it will be tricky to manage the treatment, such as fitting it around their work.7

If you have similar worries or questions, this article may help you explore why other people with type 2 diabetes have started insulin, and help you talk to your doctor about whether it’s the right time to make this next step. Check out our discussion guide that may help you get the most from your time with your doctor at your next appointment.

Meet some of the millions who overcame their worries about starting insulin

Hear from people who manage their type 2 diabetes with insulin to improve their diabetes management and quality of life.

When might I need insulin?

If your doctor has recommended insulin, it may be helpful to understand why it has been recommended for you first. This can help you explore whether now is the right time for you to start insulin.

If you live with type 2 diabetes, you know that trying to keep your blood sugar levels on target is important to stay healthy and avoid further illness later in life.8 So, if your doctor has suggested insulin, it might be because your body needs help to manage your blood sugar levels.2 Controlling your blood sugar levels can help avoid symptoms such as feeling tired or thirsty. But it’s also important to prevent some more serious long-term problems, such as heart attack or stroke.

There are different types of insulin – which one your doctor may choose to prescribe would depend on your needs.2 Most people with type 2 diabetes who need to initiate insulin are recommended to start with a long-acting (basal) insulin, which works to keep your blood sugar levels steady throughout the day.2

“I preferred not taking insulin every day. But I realised my numbers didn’t look good. Shortly after starting on insulin, my situation improved […].

I wasn’t tired. I wasn’t thirsty. It was a major change in my life.” 

- Eva, living with type 2 diabetes in Denmark

Why say yes to insulin?

Insulin has been around for 100 years and is still a cornerstone of diabetes treatment today because of the evidence that it is effective2 Insulin’s long history means there are a few myths about insulin that come from its past. But a lot has changed over the years and with ongoing innovation continuing to improve the treatment, taking insulin today is easier than ever. Technology and digital solutions can also offer support with managing insulin treatment and can help reduce the impact diabetes has on your daily life. 

What’s stopping me?

Many people find the thought of starting on insulin treatment overwhelming.3,4,5,6,7.But considering your options and taking action to have better control of your health can be a positive step.

Exploring these worries with your doctor may help -  take a look at some common questions and answers below to help you better understand what taking insulin might be like. 

“Now I have a reasonable level of control[…]. Before insulin, I didn’t have this control”.

- José, living with type 2 diabetes in Brazil
What if I’m worried about injections?

When we think about needles for injecting insulin, we often think of needles similar to those used for certain vaccinations given into the muscle, which can be longer and bigger. It’s important to know the needles used to inject insulin have also become smaller and finer over the decades.10 Your doctor can show you how to inject insulin and give you tips to making injections more comfortable. You can also find out more in this article on needle anxiety and insulin injections.

Does taking insulin mean I’ve failed?

Moving on to insulin can seem like a big step and you may feel frustrated that your previous treatment didn’t work or see it as a personal failure. But diabetes is a progressive disease and the need for insulin doesn’t mean you’ve done anything wrong. If your doctor suggests the time is right for you, saying yes to insulin is a positive step that can help you better manage your diabetes.

Could insulin give me low blood sugar?

By following the doctor’s instructions about how much insulin to take, low blood sugar (known as hypoglycaemia) can be prevented. There are also now pens and apps that can help you take the dose you need by showing you how long it’s been since your last dose and what dose you should be taking. 

Will I have to store and carry around lots of insulin?

Insulin mostly comes in pens, which are lightweight, easy to carry and discreet. The patient information leaflet will tell you how to store your insulin, but it doesn’t always have to be kept in the fridge. 

Will I gain weight?

People who start insulin often put on weight. This is because before taking insulin, if diabetes is not well controlled, excess blood sugar is flushed out in the urine.11 The insulin can help sugar (glucose) from the food you eat enter cells in your body to make the sugar levels in your blood go down. But any sugar absorbed that you don’t use for energy gets stored as fat.12 This means you may put on weight, even if you eat the same amount as before.11 You may also gain weight if you snack more to avoid low blood sugar (hypoglycaemia).13

But there are things you can do to help manage your weight, such as taking regular exercise and eating a balanced diet. It can also help to monitor your weight as you get started with insulin and keep track of your blood sugar so you don’t have to snack.

Of course, if you have any other worries or questions about starting or managing insulin treatment, you can talk to your doctor about them. 


“Taking insulin today doesn't affect my daily life like it did at first […]. So that's just to say how routine it becomes, you don’t actually think about it anymore.”

- Eva, living with type 2 diabetes in Denmark

Talking to your doctor about insulin

You’re bound to have lots of questions, so why not prepare them beforehand? Our discussion guide can help you get the most from your time with your doctor.

  1. Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.
  2. American Diabetes Association Professional Practice Committee; 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022Diabetes Care. 2022;45 (Supplement_1):S125–S143.
  3. Ellis K, Mulnier H, Forbes A. Perceptions of insulin use in type 2 diabetes in primary care: a thematic synthesis. BMC Fam Pract. 2018;19:70.
  4. Chen P, Ma X, Chen H, et al. Delays in insulin initiation among patients with type 2 diabetes mellitus in southeast China: a retrospective, real-world study. Diabetes Metab Syndr Obes. 2020;13:3059–3068.
  5. Russell-Jones D, Pouwer F, Khunti K. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab. 2018;20(3):488–496.
  6. Holmes-Truscott E, Skinner TC, Pouwer F, Speight J. Negative appraisals of insulin therapy are common among adults with type 2 diabetes using insulin: Results from Diabetes MILES – Australia cross-sectional survey. Diabet Med. 2015;32(10):1297–1303.
  7. Peyrot M, Rubin RR, Kruger DF, Travis LB. Correlates of insulin injection omission. Diabetes Care. 2010;33(2):240–245.
  8. American Diabetes Association Professional Practice Committee; 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2022. Diabetes Care 1. 2022;45 (Supplement_1): S144–S174.
  9. Alcántara-Aragón V. Improving patient self-care using diabetes technologies. Ther Adv Endocrinol Metab. 2019;10:2042018818824215.
  10. Martha M. Funnell; Overcoming Barriers to the Initiation of Insulin Therapy. Clin Diabetes 2007;25(1):36–38.
  11. Hodish I. Insulin therapy, weight gain and prognosis. Diabetes Obes Metab. 2018;20:2085-2092.
  12. Diabetes.co.uk. Insulin. Available from: https://www.diabetes.co.uk/body/insulin.html. Accessed: October 2023.
  13. McFarlane SI. Insulin Therapy and Type 2 Diabetes: Management of Weight Gain. J Clin Hypertens (Greenwich). 2009;11(10):601-7.

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