Living with diabetes blog

Type 2 diabetes treatments: Why oral meds first?

By Nancy Klobassa Davidson, R.N. and Peggy Moreland, R.N. February 13, 2013

One of our readers asked "Why is insulin only considered after oral medications have been found ineffective?" I think this is an excellent question. However, I'm not sure that I have a good answer.

An October 2008 study in Diabetes Care concluded that a six-month course of insulin therapy, compared with oral anti-diabetes drugs (OADs), could more effectively result in adequate glycemic control and improvement of pancreatic insulin producing cells in those who had new-onset type 2 diabetes with severe high blood sugar levels.

Type 2 diabetes is progressive, and the insulin producing cells in the pancreas deteriorate over time. There are an increasing number of children, teens, and young adults who are diagnosed with type 2 diabetes. They'll live longer with diabetes than others before them, and so will be more likely to develop severe insulin-deficiency that requires insulin replacement earlier in life.

Reasons why insulin might not be prescribed sooner if you have type 2 diabetes may include:

  • Doctors are concerned about you getting low blood sugar.
  • You might not be willing to start insulin or might not have the ability to give yourself injections.
  • Primary care providers may perceive that insulin therapy is too complex to manage in their busy practice.
  • Prescribing information may be vague, and the provider may be unsure about initial dosing, titration and what kind of insulin to start you on, which may delay making the necessary transition from oral medications to insulin.

According to an April 2005 article in Clinical Diabetes, an A1C level of 9 percent or more signifies the need to take action to lower blood glucose. Numerous studies have shown that early intervention with insulin is more important than was previously believed.

So, I don't have a good answer to this reader's question. However, if your oral medication(s) are no longer helping you control your blood sugar, discuss the option of insulin as a next step with your provider. Taking insulin doesn't mean that you've failed to manage your blood sugar. Type 2 diabetes is a progressive disease, and if you have it long enough, chances are you may eventually need insulin.

Have a good week,


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Feb. 13, 2013