What does "insulin dependent" really mean?

Is there an actual, medical definition of “insulin dependent”? Or is this term not used anymore since the name changes from IDDM/Type 1 and NIDDM/Type 2?

In my mind, “insulin dependent” has always meant you are dependent on insulin to stay alive in the short term, and will go into DKA and die within days without it. I have talked to many Type 2s who say they are “insulin dependent” and then go on to say they routinely skip insulin for days on end if they exercise or are otherwise running “low”. I know people who say they are “insulin dependent” even though all they use is a basal insulin (and their postprandial numbers are in a good range). Some have even been taking insulin, maybe even MDI, for years and then managed to get off insulin altogether. Nothing annoys me more than seeing someone say they were “insulin dependent” and then got off insulin by such-and-such a method, because I think, more than anything else, it’s what contributes to people thinking Type 1 can be cured.

So to me, most Type 2s who use insulin are actually not “insulin dependent”, which isn’t to say insulin isn’t required for control, just that it’s not needed for short-term survival. I do realize that some long-term Type 2s indeed are truly insulin dependent and will go into DKA quickly if they stopped taking it. But to me, if you can stop taking insulin for days on end, and/or can skip basal or bolus doses without getting into trouble with very high BG and/or ketones, that’s not really insulin dependent, is it?

Am I too narrow in my definition? What do others here think? Is there some actual, stnadard medical definition that I’ve never seen?

I think the term “insulin dependent” has become very vague, and that’s one of the reasons the medical profession stopped using it. As you have observed, the general public equates “using insulin” with being “insulin dependent”. But arguing about it is like flogging a dead horse – it’s a term destined for the dust-bin of history (eventually!).

As an aside, people ask me if I’m insulin dependent, and I don’t know what to answer. Without insulin I WOULD die (already tried it!), but for me, it’s days, not hours. I obviously do have a little insulin secretion, but high BGs quickly send my beta cells into glucotoxicity, and then I’m without insulin just like a classic Type 1. So does the inevitability of death without insulin, regardless of time frame, imply insulin dependence? I don’t know – and it’s why I’m glad the term is gone!

I have 2 CDEs and an endo who tell me I’m Type 1, but that little bit of insulin secretion is why I’m reluctant to call myself that. So I call myself Type Weird instead!

I would call days pretty short-term!

I’m on a pump, and if I were to disconnect I would probably go into DKA within a day (probably wouldn’t actually die, though), but for T1s on shots, they could stop and go for a few days before their long-acting insulin wore off completely.

I’ve sometimes wondered if it would be better to classify diabetes based on how “insulin dependent” someone is (via some sort of objective measure like c-peptide), kind of like severity or stages, and get rid of the T1/T2 classification. I don’t know if that would work, though, because of what I said above about some T2s or other types of diabetes being able to get off insulin. Plus the fact that T1 and T2 (and other more rare types of diabetes) do have completely different causes, so it might just confuse people even more!

I would concur with your definition. Merely taking insulin does not make you insulin dependent - i.e. if your pancreas still produces insulin (such as most T2s) but you take additional insulin for better control you are not insulin dependent. If on the other hand going off insulin for a day or two results in massive complications or death you are insulin dependent (T1). I think people who aren’t truly insulin dependent claim to be because it sounds a lot cooler than “I take insulin for better control.”

The primary use of the term “insulin dependent” is in the assigment of a diagnostic code ICD. Historically, they used the terms IDDM and NIDDM for insulin dependent or non-insulin dependent. These terms are stricly no longer used, instead they talk about only whether insulin is used. However, these codes and the legacy of terms pervade our treatment. Your doctor assigns and ICD to your diagnosis, it is used by insurance companies and they still use the term IDDM. It really does not matter anymore whether you “die within hours” or go forever, if you use insulin, you will be placed in the diagnostic ICD code that historically meant “Insulin Dependent Diabetes Mellitus (IDDM).”

ps. Of course realize that the ICD don’t really recognize T1 or T2 and I believe still refer to juvenile diabetes.

So a Type 2 could initially be placed in a code that is “adult-onset diabetes” and then, if they later start insulin, switched to IDDM or “juvenile diabetes”?

That’s really confusing. No wonder people (and doctors!) still get confused!

But, how does fit with T2s having difficulty getting things like insulin pumps covered, if the codes are the same for eveyrone who uses insulin?

I hadn’t Really thought about it. If you need it…you need it no matter what Type a Person is. But when I looked up insulin-dependent, I was surprised that it came up with this:


This term is still used. I heard a Resident refer to a Patient in the ER as such, a couple years back. This website was updated July 2010.

You’re right Jennifer, that time I forgot my morning shots, I was in serious DKA that evening and then into a Coma shortly after.
I honestly don’t understand how a Type 1 trying to lose weight by not taking their Insulin, can function or survive though more than a day or so. It sure doesn’t feel good. Obviously, I don’t understand the process.

That’s no longer true. The current ICD codes look like this:

2011 ICD-9-CM Diagnosis Code 250.00
Diabetes mellitus without complication type ii or unspecified type not stated as uncontrolled
2011 ICD-9-CM Diagnosis Code 250.01
Diabetes mellitus without complication type i not stated as uncontrolled
2011 ICD-9-CM Diagnosis Code 250.02
Diabetes mellitus without complication type ii or unspecified type uncontrolled
2011 ICD-9-CM Diagnosis Code 250.03
Diabetes mellitus without complication type i uncontrolled

Of course, there are other codes for complications.

Basically, if you get diagnosed in the ER as a type 1, you are given an ICD 250.01, otherwise, you are dumped in as code 250.00. But being in the diagnostic code 250.00 doesn’t mean you have been diagnosed as T2, and in either case the ICD doesn’t say what T1 or T2 is. Many people in the industry still use the terms IDDM and juvenile since that is what they are taught and those words are still in the manuals and all the IT systems. If you are given a diagnostic code of 250.00, you will be considered a T2 by insurance and have a terrible time getting a pump, even though you may to really totally dependent on insulin.

My endo says that I qualify as “insulin dependent” when my c-peptide is below a certain level. I haven’t made any for over 25 years, at least. Every new endo I see insists I redo the c-peptide test.

You wont die in a matter of days if you dont take it, i lasted about 3 weeks before big DKA x

As you can see below, 250.00 means Type 2 or unspecified. Unspecified would be those people in whom the presentation is questionable, and should be changed later when the diagnosis becomes clear, for example after an antibody or c-peptide test.

It depends on how much insulin you are making. Many Type 1’s do have some residual insulin – not enough to live on, but enough to delay DKA for a bit, like in your case. Some Type 1’s will go into DKA within 24 hours.

Anyway, please don’t do that again, OK??

There is literature that would suggest that Type 2’s should actually start therapy using insulin versus meds (pills).

As for insulin dependent all people need insulin some may need more than others. What is short term survival?

I think because the old ideas that Type 2’s can still make some residual insulin that we don’t need the the aid of a pump. Having to take several injections a day is a pain.

I was always wondering about that I think I will try to see how long I can go.

What will happen is that your BGs will slowly go up, and if you let them go up high enough for long enough, you will get sick. If you get sick enough, you could go into HHS coma (Hyperglycemic Hyperosmolar Syndrome), and that has a higher mortality rate than DKA. PLEASE don’t try this!

Dear Natalie you may be right. I think I will cut down on the apidra and keep my lantus with a low carb diet the BG will not be the best but I will not be constantly starving.

Anthony, it’s important that the BG IS the best you can do. Don’t cut down on insulin just to prove something to yourself. Insulin-dependence is a stupid word, anyway. You just need to do what you need to do to keep yourself in the best possible health. Don’t play games with diabetes – you can’t win.

High BGs will make you hungry regardless of whehter you are taking a lot of insulin or not … I don’t understand why you would want to cut back and/or stop taking insulin, but I agree with Natalie that it’s dangerous and doesn’t accomplish anything.

If you want to use less insulin the way to do it is to eat fewer carbs, exercise more, and lose weight (this is regardless of whether you are Type 1 or Type 2). I sympathize with how hard this is! But if you need insulin for BG control then you need insulin, and there’s only so much you can cut back without destroying your health.

I have read the studies that say insulin is better to start early for T2s, largely because it preserves their own insulin production rather than waiting several decades till their own pancreas has been completely burned out. Studies of T1s show that even a tiny amount of insulin production (even if it’s so little it’s not enough to survive without exogenous insulin) makes a difference in control, so every bit helps! Every time I read T2s complaining about how restrictive their diets are I wish that more could start insulin before it’s absolutely necessary for BG control.

Of course, everyone needs insulin for survival. Some are able to produce all of it naturally, some are able to produce enough to survive but not enough to control BG levels adequately, and some aren’t able to produce any. By “short-term survival” I meant days. I wasn’t trying to imply that people should let their BG run high instead of starting insulin or that T2s who happen to still have their own insulin production shouldn’t take it; it was more a question of terminology out of curiosity.

I know that pump companies are starting to try and market their pumps towards T2s (specifically, Minimed), so hopefully this will lead to greater accessibility for T2s in teh future. I personally did not mind injections, I went on the pump after 15 years of shots only because I could not achieve a good A1c with injections, but the pump should be an option for anyone who wants it.