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‘How do doctors decide when a type 2 diabetic patient should stop oral medications and start insulin injections?’ This question on Quora made us reach out to Dr Pranav Ghody, consultant endocrinologist and diabetologist, Wockhardt Hospitals, Mumbai Central, who told us that switching to insulin is not a failure, it’s a medical choice based on how your body is handling diabetes. “We look at three things: blood sugar trends, symptoms, and how well the pancreas is working,” said Dr Ghody.
If a patient’s blood sugar stays high despite maximising oral medicines, adjusting doses, and improving lifestyle habits, it suggests that the pancreatic beta cells are not producing enough insulin. At that point, injections become a safer and more effective option, said Dr Ghody.
Adding that there are clear indicators, Dr Ghody explained that when HbA1c remains high (usually above 8.5-9 per cent ) even after adequate medication, or fasting sugars stay above 150-160 mg/dL, insulin comes into the picture. “Severe symptoms — frequent urination, excessive thirst, unexplained weight loss, fatigue — also indicate that oral medicines alone are no longer sufficient,” said Dr Ghody.
Doctors also consider specific situations, such as pregnancy, high infection rates, surgery, acute illnesses, kidney or liver problems, or when steroids are prescribed. “In these instances, insulin is started early because it provides better control and is easier to adjust,” said Dr Ghody.
This is what Type 2 diabetes patients should know (Photo: Freepik)
Once someone starts insulin, do they stay on it forever?
Not always, contended Dr Ghody. “Some people need insulin only temporarily — for example, during infections, after surgery, or when glucose levels are extremely high at diagnosis. Once the body stabilises, many can return to oral medicines. However, for others, especially those with long-term diabetes or declining pancreatic function, insulin becomes a long-term necessity.”
Why do young adults with type 2 diabetes sometimes need insulin earlier?
That is because the disease has evolved, said Dr Ghody. “Younger patients often face higher stress, irregular lifestyle patterns, sleep deprivation, and early insulin resistance. If the pancreas is overworked, it can burn out faster, making insulin necessary much sooner than expected,” said Dr Ghody.
Here’s what you should consider (Photo: Quora)
What should patients consider before resisting the idea of insulin?
Insulin is not a punishment; it’s a protective tool, said Dr Ghody.
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*Better sugar control lowers the risk of kidney damage, nerve issues, and heart disease.
*Modern insulin pens are simple, painless, and safe.
*The goal is to improve both longevity and quality of life, not to avoid injections at all costs.
And most importantly, decisions about switching to insulin should always be made in consultation with an endocrinologist, said Dr Ghody.
DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.
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