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Insulin Replacement Therapy for Type 2 Diabetes

Medically reviewed by Regina Victoria Boyles, MD · Pediatrics

Written by Lorraine Bunag, R.N. · Updated Dec 18, 2022

    Insulin Replacement Therapy for Type 2 Diabetes

    Insulin replacement is common for people with Type 1 diabetes, but Type 2 diabetics may also need it. Here’s what you need to know about Type 2 diabetes mellitus insulin management.

    How Diabetes is Treated: An Overview

    Diabetics generally have a problem in producing or using insulin. Insulin is a hormone that our pancreatic beta cells produce to allow our body to use sugar for energy. The inability to produce or use insulin results in high blood sugar, which over time, can lead to various complications. Some of those complications are nerve damage, blindness, and diabetic foot.

    There are two types of diabetes – type 1 and type 2. People with Type 1 diabetes, in essence, cannot produce insulin. On the other hand, Type 2 diabetics can produce insulin, but they have difficulty in using them (insulin resistance).

    The result is the same, however – increased blood sugar levels.

    As mentioned, poorly managed blood sugar levels can cause a lot of serious health concerns. For this reason, diabetics need medical help. Your treatment regimen usually depends on the type of diabetes you have.

    • Doctors prescribe dietary and lifestyle changes for Type 2 diabetics. Sometimes, these changes are accompanied by oral medications that lower the production of glucose. Other medications also work on increasing the ability to use insulin. A common medication that can do both is Metformin.
    • On the other hand, since Type 1 diabetics cannot produce insulin, they need to “replace” the hormone via insulin replacement therapy. This approach not only supplies the needed insulin but also mimics how our body delivers it.

    However, there are times when patients with Type 2 diabetes will need insulin replacement.

    When to Take Insulin for Type 2 Diabetes

    At this point, you must be wondering, if Type 2 diabetics can make insulin and just have a problem in using them correctly, why would they need insulin replacement therapy?

    Doctors agree that Type 2 diabetics mostly just need help in absorbing sugar and using insulin. However, if their diabetes is progressive, insulin replacement might just be the only effective treatment for them.

    But when does Type 2 diabetes become progressive?

    Experts explain that while the initial problem is only insulin resistance, Type 2 diabetics also face progressive beta-cell failure. It means that they, too, can be eventually insulin deficient, if the beta cells will not produce enough insulin.

    So, to clarify, patients with Type 2 diabetes may need insulin replacement therapy if they are no longer achieving their target sugar levels. This is despite taking medications and performing optimal dietary and lifestyle interventions.

    Besides progressive diabetes, the doctor would also look into the patient’s sugar levels and comorbidities (liver,  kidney problems, etc.) that hinder them from receiving oral medicines.

    type 2 diabetes mellitus insulin management

    Type 2 Diabetes Mellitus Insulin Management

    To better understand what will happen once you incorporate insulin replacement therapy in your treatment, take note of the following concepts:

    Insulin replacement will mimic the body’s insulin delivery system

    Our body releases insulin in two ways – background and prandial.

    • The background pattern continuously secretes insulin in small amounts.
    • In the prandial pattern, our body rapidly secretes insulin and the amount depends on the rise of sugar in our blood.

    Type 2 diabetes mellitus insulin management mimics these patterns of secretion. Basically, we have the basal insulin for the background pattern and the bolus insulin for the prandial pattern.

    You may need to use more than one type of insulin

    Because the idea is to mimic the body’s way of secreting insulin hormone, replacement therapy involves several kinds of insulin. They are:

    • Rapid-acting, which works within minutes of administration and its effect can last for up to 5 hours.
    • Short-acting, which works in about half an hour after administration. Its effects can last for up to 8 hours.
    • Intermediate-acting, which works around 2 hours after administration and its effects can last for up to 24 hours.
    • Long-acting, which works an hour or so after administration. Its effects, however, can last for 24 hours.
    • Mixed insulin is a combination of either rapid-acting or short-acting and intermediate-acting insulin.

    It’s possible to start with an augmentation treatment

    In augmentation treatment, you will receive insulin along with oral medications. The insulin can be basal (released continuously in small amounts) or bolus (released at once, in larger amounts in response to sugar levels).

    On the other hand, replacement therapy will have both basal and bolus insulin. Typically, 50% of the total insulin dose for the day will be basal. The other 50% will be bolus, but will be divided for breakfast, lunch, and dinner.

    Furthermore, according to the American Diabetes Association:

    • Most Type 2 diabetics need just one injection per day without taking any diabetes pills.
    • Some may need to take diabetes pills together with a single injection, commonly administered in the evening (dinner or bedtime).
    • If the pills have stopped working, the patient may need to receive 2 injections daily consisting of two different types of insulin.
    • Over time, they might need 3 or 4 injections daily.

    There are several ways to administer insulin

    For Type 2 diabetes mellitus insulin management, you’ll have several ways to administer the hormone:

    • Syringes. This is the most common method of administration. However, each syringe is single-use and must be disposed of properly after use.
    • Insulin pens. These look like regular writing pens, but they have a cartridge containing the insulin. While the pen is typically not disposable, the pen needles are.
    • Insulin pump. An insulin pump is a small device worn outside the body. Attached to it is a tube with a needle, which is inserted into the skin near the tummy.

    Final Reminders

    Once your doctor talks to you about the need for insulin replacement, expect to discuss things that relate to the following:

    • Glucose control
    • Possible adverse reactions
    • Factors to consider in choosing the type of therapy
    • Cost to adhere to insulin replacement

    Listen carefully to their explanation and make honest comments when some aspects are not clear to you or if you have any questions connected to your health.

    Finally, remember that Type 2 diabetes mellitus insulin management is a comprehensive approach. It still involves diet and nutrition as well as lifestyle modifications.

    Learn more about Diabetes here. 


    Hello Health Group does not provide medical advice, diagnosis or treatment.

    Medically reviewed by

    Regina Victoria Boyles, MD


    Written by Lorraine Bunag, R.N. · Updated Dec 18, 2022

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