Diabetes Medication

Start Taking Insulin Now

You can avoid the worst consequences of diabetes if you take insulin soon after a doctor tells you that you have the disease, recent studies show. You can even drive your diabetes into remission and preserve the beta cell function of your pancreas that you otherwise could lose. When your beta cells don’t work well, it’s even harder to manage your diabetes.

While everyone who has type 1 diabetes has to take insulin, of course, only one-fourth of people with type 2 diabetes do so far, usually after years of failure on oral diabetes drugs. After you have tried one of them after another, and your blood glucose is still too high, people may have to go on insulin, although usually with reluctance. You still hear people with diabetes telling you with pride, “I don’t have to take insulin.”

Shape Up

Even worse is that some doctors even use it as a threat, saying something like, “If you don’t shape up, I’m going to make you inject insulin.” But by that time most of the beta cells of your pancreas that store and release your own body’s insulin into the bloodstream have also failed.

Instead, taking insulin right after your diagnosis can stop the typical progression of diabetes from bad to worse. Research by a team of doctors at Toronto’s Mount Sinai Hospital suggests that when you take insulin for a short term soon after your diagnosis of type 2 diabetes, it can have long-term and very positive effects. The conventional wisdom has it all backwards, they say.

Led by Dr. Ravi Retnakaran, M.D., an endocrinologist at Mount Sinai’s Leadership Sinai Centre for Diabetes, the team demonstrated that when introduced early in the course of diabetes, treatment with short-term insulin therapy for two to three weeks can restore the body’s ability to make and use its own insulin.

Who It Works For Best

The treatment doesn’t work for everyone. People who at the start of their treatment with insulin who have lower fasting blood glucose levels are more likely to achieve remission of their diabetes than people with higher levels. But surprisingly, people who had a higher body-mass index were more likely to get remission. After one year about 46 percent of all of the people studied were still in remission and after two years the proportion was 42 percent.

“Traditionally, by the time the patient is prescribed insulin therapy to treat diabetes, it’s too late to reverse the disease process,” Dr. Retnakaran says. “When we treat patients temporarily with intensive insulin therapy for three weeks early in the course of disease, it is possible to improve the ability of the body to make and use its own insulin.”

He hopes that his group’s studies will encourage the medical community to use this new strategy “to potentially reverse type 2 diabetes in its early stages.” If that were permanent, it would be huge news. But even a one or two year holiday from high blood glucose that intensive insulin therapy already offers would greatly improve the quality of life for many of us.

The ADA/EASD Position on Insulin

But the standard treatment recommendations are in flux. The American Diabetes Association and the European Association for the Study of Diabetes now recommend in their current position statement that doctors consider insulin as a part of the initial therapy for people with type 2 diabetes.

If you want to regain your health, taking insulin is the quickest way to get there. While a very low-carb diet can work wonders, some people find it difficult to give up the bread and sweets and others are still suspicious of the amount of fat you need to eat for energy. None of the oral diabetes drugs can bring your blood glucose level down to normal nearly as quickly as insulin can.

Your doctor will probably be pleased to hear your request to take insulin, especially if he or she has been nagging you to take it. The beta cells in your pancreas that have been working so hard ever since you got diabetes will also be happy, appreciating the break that taking insulin will give them.

When it comes to taking insulin, don’t save the best for last. This might work for eating dessert, but it doesn’t make sense for your health.

This article is based on an earlier version of my article published by HealthCentral.

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  • Marcus Valdes at

    I haven’t read his book yet (I’m going to), but I have watched all of his videos on YouTube.
    They make sense.
    I’ ve lost 30 lbs. eating low carb but still have a ways to go.

  • Holly Stewart at

    Hi David, Have you had a chance to read Dr Jason Fungs new book, The Obesity Code? He explains how increased insulin leads to increased insulin resistance. How can his work be so contradictory to the studies you list here? Thx for helping me understand. By the way, I love your newsletter!

    • David Mendosa at

      Thank you, Holly. I haven’t had a chance to read that book yet.

  • Stephen Klinger at

    David, I would really appreciate it if you could cite some references regarding your discussion of insulin resistance above, and the biochemical process involving fat cells. On a related subject, I just read an article on fasting that suggests that at some point ketosis (from fasting or presumably even a near-no-carb diet) can be harmful to the brain because the fat cells being broken down to fuel the body’s energy are too large to pass through the blood-brain barrier.

    • David Mendosa at

      I suggest that you first review my earlier articles, Stephen. As to ketosis, there is certainly a lot of misinformation on the Internet!

  • george pereira at

    what if diabetes is due to insulin resistance. then sufficient insulin is produced but not utilised by the body effectively. is there a need to start insulin injections?

    • David Mendosa at

      Yes indeed, George. Type 2 diabetes IS due to insulin resistance. The pancreas pumps out a lot of insulin, but it’s still not enough to break through the fat surrounding the cells that need it. So in the short term people with type 2 do need even more from injections. That also helps to put less stress on the pancreas so it won’t burn out from overuse. Of course in the long term the key is to get down to a low normal BMI weight so that the cells of our bodies can better receive the endogenous insulin the pancreas produces. Sadly, few people with diabetes are able to lose enough weight, although I have found that a very low-carb diet does that very well, and I no longer need to use any diabetes drugs.

  • Simona Gherghisan at

    Hi, David! I was one of “those” people scared of insulin and thinking that once I take it I will be stuck with it for the rest of my life 🙁 This article sends me for a loop! Are you able to explain in more detail how this insulin/beta cells relation happens? I had type 2 diabetes for 5 years now and still struggle with weight control and have an aversion for needles so I don’t check my sugar.
    Should I try insulin? Will I be dependent on insulin for the rest of my life? Is it too late for the insulin to help the beta cells?
    Thank you for taking the time to read my email.

    • David Mendosa at

      Simona, if your blood glucose is out of control, you may well need to take insulin. That absolutely does not mean that you will be on it the rest of your life! What is your current A1C level? Please tell me that first.

  • Stephen Klinger at

    I agree that insulin can be useful, and sometimes life-saving for type 2s. The trouble with relying on insulin once you start taking it (as a type 2) is the temptation to eat more of what you like (starches and sweets) and attempt to cover the carbs with more insulin. As Dr. Bernstein frequently points out, and as I have learned over the years, the more refined carbs you try to sneak into your diet the more your blood sugars creep up, and the more insulin you require. You are always chasing the effects of your diet because you simply can’t cover a lot of carbs, and what you are really doing is increasing your insulin resistance. Insulin also produces a weight gain in most people.
    When my wife recently switched to an Atkins-type diet for weight control and starting preparing her own low-carb recipes I resolved to lower my own carb intake from maybe 100-120 a day to about 50 (she is consuming no more than about 20), and I immediately saw a dramatic drop in my blood sugar readings and more sensitivity to insulin, so that I am able to lower my doses dramatically.

    • David Mendosa at

      I certainly agree with you, Stephen, that a very low-carb diet is the best way for anyone who will do it to manage diabetes. You and I know from our personal experience that it really works.