At present, a life of insulin therapy is guaranteed if you have type 1 diabetes. This isn’t always the case if you have type 2 diabetes, however. People with type 2 diabetes may use insulin at varying points in their life and safely return to oral medications a number of times.
Conversion to insulin therapy can happen anytime a person’s blood glucose control decompensates due to extra stress placed on the body. The stress response elevates the level of the hormones epinephrine and cortisol, increasing the amount of glucose manufactured from available carb and protein), and spurring the breakdown of stored glucose in the liver. Both of these processes ultimately drive the blood glucose level up.
Sometimes this happens when people are initially diagnosed. If blood glucose levels have been significantly elevated for a long period of time, a condition known as glucose toxicity can result. High glucose levels are toxic to the beta cells and they lose their ability to secrete insulin. A vicious cycle occurs with higher glucose levels suppressing insulin output from the beta cells which drives the blood glucose level even higher…and the circle continues.
Under conditions of very high glucose levels and temporarily incapacitated beta cells, initiation of short-term insulin therapy is an effective tool to quickly reduce glucose levels, eliminate the glucose toxicity and allow transition to glucose lowering pills.
Other times short-term insulin is used are during episodes of acute injury, infection or surgery. Often patients, whose metabolic control is at goal when at home, will require insulin during hospitalizations, especially if their diagnosis includes infection or myocardial infarction. Elevated glucose levels accompanying heart attacks can occur even in patients without diabetes and are a marker of poorer outcomes.
Patients may find that they require the aid of insulin when corticoid steroids such as prednisone are given. Even cortisone injections used to relieve joint discomfort can elevate glucose levels dramatically over the course of a few days.
Finally, use of insulin therapy can accompany the announcement of happy news. Although oral agents have been used successfully during pregnancy, insulin remains the therapy of choice for many pregnant women.
Because the transition from hospital to home can sometimes involve gaps in communication between doctors overseeing care in the medical center and patients usual health care providers, patients who are put on insulin in the hospital should inquire of their health care providers’ if/when a return to their usual medication regimen can be expected.