Because the pancreas produces very little or no insulin in people with type 1 diabetes, insulin for these people is a lifelong requirement.
According to the Best Practice Advocacy Centre (BPAC) New Zealand, ‘Insulin should be considered in all people with type 2 diabetes who have unsatisfactory glycaemic control, despite lifestyle support and maximal oral hypoglycaemic agents. For a patient with significant hyperglycaemia who is already on maximal oral agents, the move to insulin should be immediate. The presence of diabetic complications and personal patient preference may also influence the decision to initiate insulin’ (p 2). It has been suggested that insulin is not being initiated in line with treatment guidelines. The INSTIGATE study of people with type 2 being started in insulin in five European countries concluded that insulin was initiated only after HbA1c levels had been considerably higher than recommended guidelines for a considerable time (Jones et al 2009). BPAC (2012) notes that the HbA1c level at which insulin should be initiated differs by individual but that insulin should be viewed as just another step in the treatment ladder. Action in terms of starting and titrating insulin should be taken if the HbA1c level is unacceptable for a particular individual.
