Talk to me about type II using insulin in addition to oral meds

I am considering asking my doc, after years of saying no needles, to add insulin to my medications. I’d like to use the kind of insulin that is short term, and used only as necessary for that time, to start. But before I say anything, I’d like to know some reactions from people who have tried it. Did it work for you, what were the complications, what were the good things…ideas, thoughts, comments.

Thanks so much
Cathy J

I think im going to do the same thing, i dont want any meds at all, i will keep with the BP meds but want insulin now to get this under the best and fastest control i can


There are pros and cons of using insulin together with your oral medications. I think the first thing that you have to consider is how high is your blood sugar levels (consider both the random accu checks and your 3 month A1C). And, second do you honestly make an effort to lower your blood sugar levels and how long have you been trying…I think if you consider these factors, for sure you will know for yourself if you really need to incorporate insulin to your oral meds. Actually, you don’t have to ask your doctor if you need insulin…the doctors will tell you if you need one. If your case is like mine, my sugar levels are quite high in the high 200s and mid 300s and I can honestly tell you that my efforts of lowering my bs are not that committed and it’s been more than 5 years that I’ve been trying with ups and downs, then for sure incorporating insulin together with the oral meds is a good decision. If you’re in the max. dosage of meds for diabetes and to prevent further damage to your organs, like kidney (kidney failure), then having insulin shots will help you to stabilize your bs level. Actually, insulin compared to other oral meds doesn’t have side effects that damages organs (kidney, liver, pancreas) according to my doctor. However, be prepared of sticking a needle to yourself. The first time is the hardest since the thought and actually doing it (sticking a needle) is a mind boggling thing for me since I hate needles. It took me an hour and a half to do it. Also, after some time, you’re running out of injection sites. Also, be prepared to gain weight. I think that’s the bad part of insulin is that it makes me gain weight. Also, I find it very hard to go on a diet since there are times that my sugar is very low. The constant trips to the doctor to adjust the dosage of the insulin is another thing and being consistent is important. But, upon using the insulin, I can see the result immediately in my bs…it went down and much more stabilized. I suggest to you to really think it over and if you did all your best to diet and exercise and still your sugar level is high, I think you need to add insulin to your meds…and in the event that you are not so committed like me in lowering your sugar level, I suggest that insulin is a good way to go to lower your bs level. I hope these informations and or comments will help you…but for the meantime, keep on smiling :slight_smile:

Hello Cathy. I think Mayla’s answer hit it right on. It will highly depend on how high your daily blood sugar level is. When I was first diagnosed, my blood sugar was very high ( 200 and up). At first I was on insulin shots. With constant diet and exercise, Im averaging now from 90 to 150. My endo changed my medication to a combination of glimiperide 2 mg and metformine 500 mg. ALthough unlike insulin, oral meds does not work as fast. And I really have to be consistent on my diet and physical activities. One thing going for me though…I hate needles!

I am a T2 diabetic diagnosed 12 years ago and tried all the oral meds that were available including Byetta and never got my BG under control until I went on Levemir, which is a basal or long acting insulin. What a blessing! After I finally got my dosage correct and then having hope once more, I started on a reasonable diet and my BG daily averages have been in the upper 90’s. ( I test 6x daily). I also take 1000mg metformin 2x daily to help the levemir ‘smooth’ out throughout the day. It probably saved my life. So, yes, if you need it to help with the control then do it. Also check out Jenny Ruhl’s article on Insulin on her blog “Blood Sugar 101”. Jenny’s a poster here on TU Diabetes forums and her blogs helped me get my act together and thrive.

Insulin can make all the difference in the world, it has for me. I’ve never heard anyone say they started on a short acting insulin. I have only heard, as in my case, people starting on a basal type insulin. I would think bolusing opens you up to a whole new set of complications, especially if your pancreas is still producing insulin on it’s own.

I was completely unable to get my sugars under control through diet and oral meds until the Levimir came along. I am now almost down to a normal fasting number in the morning and my food spikes are not as high as before, nor does that high last as long as it did before the Levimir.

I think you should keep it as simple as possible, A long lasting insulin, once a day(sometimes twice) works all day and you don’t have to do the math for bolusing and inject X amount of time before meals.

The greatest thing I have learned from all the back and forths between types is the grass is not always greener on the other side. Bolusing insulin is a constantly changing type of thing and difficult to manage, if you’re sick, hormonal, or even just stressed your body will utilize the insulin differently opening yourself up to extreme lows and sometimes highs that just wont go away.

Personally, I wouldn’t use a short acting insulin until I have exhausted all other choices.

You don’t really say why you are considering this, what meds are you on and how is your control now?

Michael and Samantha,
My doctor is talking about putting me on Levimir next month along with my metformin. She tells me I won’t gain weight on this and I’ll be able to continue losing weight. Do you find this to be true?

I’d like to know the answer to this question, also. So far, I haven’t found a med yet for diabetes that doesn’t have “may cause weight gain” as a side effect. If you hear of an answer, please let me know.

Cathy J

I have been on insulin and on oral meds, and am currently on Byetta, which thank the Lord, is working for me.

Insulin made me gain weight, yes, even Lantus and Levemir.

What your endo will probably do is run a c-peptide or a GAD immunity test and possibly an insulin resistance test to see how your pancreas is functioning now.

You can run the risk of burning out what little Beta cell insulin production you have now by going on Insulin too early. That is my case.

However, when I was on insulin, I found my life was a little freer in the sense that I could eat more of what I wanted, although I did do a low-carb diet then. Of course, it wasn’t freer in the sense that I did have to test more frequently, and I did have to inject more frequently. Now, I really have to watch my diet more. Also, I had to watch how I exercised when I was on insulin.

There are pros and cons to every management plan, but if you can get away with your pancreas working, even at half speed, for as long as you can, I would say give it a chance.

But you are so good and right to want to be aggressive about managing your T2. So many of us don’t get the benefits that our counterparts, T1’s, have - that sense of early advocacy and ownership of our condition, so we tend (notice I am generalizing here) to not manage our disease as urgently.

It’s good to be on top of things, and read, research, and talk to others.

Everyone’s diabetes is different, but having a great attitude in wanting to lick it is always good!

Oh, and btw - my BSs were managed under insulin, but never as low as they have been now w/ Byetta and Metformin for 6 mos.

Good luck and Godspeed!


well… it’s kind of a balancing act. If your insulin dosage is correct, your weight should remain relatively stable. If your dosage is too high, you will eat more to cover the lows. If your dosage is too low, your body will start converting the extra sugar in your blood stream to fat cells. yeehaw!! Love the D!!



Some people have lost a lot of weight with metformin. Insulin will cause weight gain. You can try combining it with metformin or avandia to combat that. Or a hell of a lot of exercise which is really good to help reduce insulin resistance.

Dear Kathy.

Your doctor is an optimist. It will need a lot of exercise to combat the potential weight gain.

I have read all the comments and thank you all so very much for sharing your experiences with me. Please trust me when I say that I DON’T want to go on insulin, it has always been my contention that I would stay as far away from a needle as I could. However, in answer to some of your questions.

  1. I have lost 50 lbs in two years…and 29 of that twice, due to using Avandia.
  2. I do faithfully follow every rule, regulation and suggestion that is given me by my diabetic team. I exercise five times a week, even though I am doing it on arthritic knees…swimming and biking. for 60 and 30 minutes respectively.
  3. I eat very healthy meals, not pre-prepared ones. My husband is a chef and has been very helpful in decoding the ingredients to things that I can eat and still have the flavor there. Bless his heart!
  4. I do have a problem with chocolate, and limit myself to an ounce of sugar free when I can’t bear to not have a piece.
  5. I take my BS levels four times a day faithfully as my diabetic team have asked me to do.
  6. I drink almost 68 ounces of water everyday, any more and my high blood pressure meds would be at risk.

So, I am not falling short very many places. I have been dealing with High bp; arthritis, diabetes, and some emotional things for a long time…I think I am doing well…except that my numbers are still in the 150’s when I want them in the 120’s or lower. But, shots, nope, I’m not excited about that, but I am excited about getting in control. We are doing some changing of things, and rearranging of meds…so maybe it’s just a matter of tweaking the machine. Who knows, this disease is so very individual—it’s amazing they don’t have to come up with meds for each of us that are different.

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I have been on Levimir for about a year now 16units at night and Novolog for my short acting for meals. along with the metformin extended release 1500mg with dinner. I was originally put on oral meds for about 2 1/2 yrs and always had high glucose and seemed to be starving myself for fear of going high then I started insulin first a novolog mix 70/30 and it was a rollercoaster lots of lows, then went to the long acting and the short and it was the best thing that ever happened A1C came down and the best part was I could eat and plan my dose around what I was eating. I had no weight gain from the metformin and have been on it for 5 yrs.

Dear cathy.

The needles are a triviality and the finger pricks are much more painful. BG in the 150’s are not good. You will kill your pancreas dead. A little insulin now might be a good thing if you wait you will need a lot of insulin.


Hi, I’m new to this forum, I have been taking insulin for the past 6 yrs now…here are my meds:
metformin at dinner 2000 mg…with 10 byetta plus Humalog with a sliding scale depending on my BS at the time
usually around 30 units…at bedtime 70 u of lantus…

Peter H Diegel

Not worried about the needles as a “pain” thing, just don’t want to go there…but life is life,and I am the one who brought it up. Yet, in order to get the insulin my doc has to write the script AND monitor it with me. In my case, I totally believe in a team concept. I have an excellent team of medical and theraputic professionals who are working with me on health issues. If you read my previous posts, you’ll note that this diabetic disease is not the ONLY thing I have going on…so 150’s with the amount of pain I have with the arthritis is not abnormal.
It’s just not the “perfect” I want. So we’ll talk. Sometimes, Anthony, you have to look at the total picture to get the small bit in the corner. Thanks for your suggestion, I’ll take it to the team, along with my request for consideration.


I have been on Levimir for 2 or 3 months now and I have been gradually losing weight still. I have been very cautious about my food intake and still have room to cut down on calories, fat and carbs. I have not gotten into a routine exercise program yet, but I do work on my feet and run constantly while there, so I am sure this helps some.

The weight gain is something that might happen. It really depends on how much work you want to put into maintaining or losing from where you currently are at. And, I’m sure it has everything to do with how you are genetically programed for weight gain/loss.

Good Luck. Levimir has made my D so much easier to maintain.

May I borrow your chef…

I work in a restaurant and am trying to get the chef to change some of his foods. We have what seems like a large percentage of people with allergies and/or diabetes that come to eat at our place and it is very difficult to find food we can eat. So far I have met with resistance from most of the management team (by the way, this includes my husband!) The catch phrase so far has been ‘nobody will eat that crap’. Although, the few times I have gotten him to alter some recipes they were the hottest selling specials for the weekend. Maybe, just maybe, I’ll win this battle with them…

Congrats on working so hard to control your diabetes. Sorry your numbers aren’t where you’d like them to be, but it’s impressive you’re so on top of them and want to make necessary changes.

As most people with type 2 find out, your body changes (insulin resistance continues and insulin production by the body decreases) to the point where adding outside insulin is the best way to tame blood sugars. That’s a biological fact and has nothing to do with willpower, etc.

If you are already controlling your total calorie intake and getting regular excercise, adding insulin won’t necessarily cause weight gain. And, in any case, it’s not the insulin that adds the weight, it’s the insulin working on excess calories that can add weight. Many doctors don’t stress enough that adding insulin is also a good time to re-look at a person’s calorie and meal-plan targets.

Recent research indicates that the EARLIER and more aggressively blood sugars are managed, the better the long-term outcomes.

Another thing to discuss with your team are the other blood glucose-lowering drugs that are more weight-neutral than insulin: the DPP-4 inhibitor pills (sitagliptin/Januvia is FDA approved; saxagliptin/Onglyza, dutogliptin, and alogliptin are under review; vildagliptin/Galvus is approved in Europe) and the incretin mimetic injectables (exenatide/Byetta is approved for use with meals and ligraglutide, a one-a-day injection is under review).

I hope you are able to make some med therapy changes soon that you feel good about. There is some trial-and-error when any injectables are added.

PS: if you worry about shots, look seriously at pens. They’re a little less obtrusive than vials and syringes, but may be more expensive depending on whether you have coverage or not. Best wishes, and let us know how it goes!