When is it necessary to start insulin therapy?

Okay, let's talk about this topic that many people are concerned about, and maybe even a bit scared of – when exactly is it time to start insulin?

Don't worry, it's not as scary as it seems. I'll try to explain it in plain language to help you understand.

When Do You Need to Start Insulin Therapy?

Think of insulin as the "key" in your body that manages "blood sugar," the energy source. With this key, blood sugar can enter your cells to provide energy. If there aren't enough keys, or if the keys don't work well, blood sugar builds up in the bloodstream, causing high blood sugar (hyperglycemia).

So, when do you need to get these "keys" from outside? Mainly in these situations:

1. Newly Diagnosed Diabetes with Sky-High Blood Sugar

Some people are diagnosed with diabetes when their blood sugar is already very high (e.g., fasting blood glucose over 11.1 mmol/L, or HbA1c greater than 9%).

Analogy: It's like your pancreas (the factory that makes the "keys") has been overworked for so long it's almost ready to "strike." At this point, oral medications, which act like "prodding," might not be very effective and could even add to its burden.
What to do: Doctors usually recommend starting insulin for a period; this is called "intensive insulin therapy." The goal isn't for you to take it forever, but to give your pancreas a "break" to recover. Once blood sugar stabilizes and pancreatic function improves, many people can switch back to oral medications, or even manage their blood sugar through lifestyle changes alone.

So, in this case, insulin is more like an "emergency responder," putting out the fire first.

2. Type 1 Diabetes

This situation is clear-cut. Type 1 diabetes occurs because the body's immune system malfunctions and "destroys" the pancreatic factory, making it completely unable to produce insulin (keys).

Analogy: This isn't the factory being tired; it's the factory going out of business.
What to do: Since there are no "keys" in the body at all, they must be supplied from outside. Therefore, people with Type 1 diabetes need lifelong insulin therapy from the moment of diagnosis; it's essential for survival.

3. Blood Sugar Still Not Controlled Despite Multiple Oral Medications

This is the most common situation for many people with Type 2 diabetes. You might be diligently controlling your diet, exercising regularly, and taking two or even three types of blood sugar-lowering pills, but your blood sugar (especially HbA1c) still isn't coming down.

Analogy: Your pancreatic factory, after years of operation, is exhausted, and its production capacity is severely reduced. No matter how hard the oral medications – acting like "managers" and "stimulants" – try, they can't squeeze out any more "keys."
What to do: This indicates that oral medications have reached their limit. At this stage, the most direct and effective method is to supplement with insulin. This doesn't mean your previous treatment failed; it's a natural progression of this chronic disease. Adding insulin is like "airdropping" direct support to your body, with immediate results.

4. Certain Special Situations

Even if your blood sugar is usually well-controlled, you might need insulin temporarily during specific circumstances:

During Pregnancy (Gestational Diabetes): For the safety of both mother and baby, blood sugar needs to be controlled very strictly. Since many oral medications aren't suitable for use during pregnancy, insulin becomes the safest and most effective option.
Before Major Surgery: Surgery itself is a stressor that can raise blood sugar and affect wound healing. Using insulin before and after surgery helps keep blood sugar stable during this period.
Severe Infection or Trauma: When the body is fighting a serious illness, blood sugar can spike. Insulin is needed to "bring it down."
Development of Severe Complications: Acute complications like diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) require immediate insulin treatment for rescue.

Don't Scare Yourself About Insulin

Many people panic when they hear they need insulin, feeling like it's the "end of the road," that they'll "get addicted," or that they'll "be stuck with it for life." These are actually misconceptions.

Not the "End," but a "New Path": Starting insulin means your treatment is entering a new phase, aimed at better protecting your body and preventing complications.
Not "Addiction," but a "Necessity": It's about replacing what your body lacks, just like drinking water when you're thirsty. It's a physiological need, not drug addiction.
Not Necessarily "Lifelong": Except for Type 1 diabetes, insulin is often just a temporary treatment tool in many situations (like the first and fourth points mentioned above).

In short:

Whether you need insulin, which type, and how much, is ultimately up to your doctor. They will decide based on your specific blood sugar levels, HbA1c, pancreatic function, lifestyle habits, and overall situation.

What you need to do is openly communicate your concerns with your doctor, then trust and follow the professional treatment plan. See insulin as a powerful "new teammate," not a scary "enemy," and your journey to managing blood sugar will be steadier and go further.

Hope this helps! Don't just wonder on your own – talking to your doctor is the right way to go!