Presently, it is necessary for all patients with type 1 diabetes to take insulin by injection or pump. This is because they are profoundly deficient in insulin, which is essential for life. No other therapies can restore insulin in a person with type 1 diabetes apart from giv- ing the hormone itself.
In the case of type 2 diabetes, the majority of patients can be controlled with one or more pills for their dia- betes, usually for several years. The available types of oral medication for diabetes usually either improve the body’s ability to make insulin, or make the body tissues more sensitive to it. Frequently, patients will take a combination of medicines that do both. A little over a decade ago, only one type of pill was available for dia- betes in the United States but now there are at least six different classes of pills. Thus, by taking a combination of these, it is possible for people with diabetes to remain off insulin for longer, sometimes for many years. In addition to the blood glucose level, there are other factors that predict whether a person with type 2 diabetes will be likely to require insulin therapy earlier. People with type 2 diabetes who are not significantly overweight tend to require insulin treatment fairly early. About one out of every five people with type 2 diabetes actually seems to have a partial form of type 1 diabetes (the abbreviated name of which is LADA, short for “latent autoimmune diabetes of the adult”), based on clinical features, presence of related condi- tions or measurement of markers of immune attack against the insulin-producing cells of the pancreas (known as autoantibodies) in the blood. This partial form of type 1 diabetes appears to have become arrested before it became very severe. However, people with LADA usually respond better to insulin treat- ment than to pills.
In spite of the presence of indicators of LADA, the usual approach is to treat a patient with pills whenever it appears safe to do so. This means that certain people with a high blood sugar level who are being given a trial of pills will need to be followed very closely for the first few days or weeks to be sure that the blood sugar is responding. They will also need to check their own glucose and report these values to their physician or diabetes educator.