A common question I hear is, "Why does it seem like my diabetes pills and other injectable diabetes medications don't seem to work as well over time?" This is commonly referred to as "pill failure" or "beta-cell failure" by endocrinologists.
Recently, I met a woman who was upset that no health care provider or diabetes educator had explained to her, at the time her diabetes was diagnosed, that diabetes is a progressive disease. She thought that if she "behaved herself," her diabetes could be cured, or at least stay in holding pattern.
But type 2 diabetes is progressive in nature. Even if a person has high blood glucose levels at the time of his or her diagnosis, he or she is often able to manage the diabetes by losing weight, maintaining a healthy diet and exercising. Whether that's possible depends on what I call the "state of the pancreas" and how well the beta cells are functioning. I've only seen a few people control diabetes by diet and exercise alone for more than 20 years. But most people I see who've controlled their type 2 diabetes this way eventually also need oral diabetes medications, non-insulin injectable diabetes medications or both, an average of 7 to 10 years after the initial diagnosis. Of course, this varies per individual, and everyone is different.
The longer you have type 2 diabetes, the less responsive the beta cells are, and, over time, the insulin producing beta cells in the pancreas are no longer able to release enough insulin. This happens even with the assistance of oral diabetes medications and non-insulin injectable diabetes medications. Oral and injectable diabetes medications are not insulin and work in various ways to stimulate the production of insulin and the absorption of insulin into the cells, to reduce the output of glucose from the liver, to slow the absorption of carbohydrates, and even to spill extra glucose out of the kidneys. At a certain point in the progression of diabetes, insulin or insulin in combination with the other oral diabetes medications is necessary to control blood glucose levels.
When people who take oral diabetes medications progress to needing insulin, they often feel as if they've done something wrong to prompt this transition. Unfortunately, it's just the progression of diabetes and can't be avoided in those instances. Insulin is a hormone and generally doesn't interact with other medications; the primary side effect is hypoglycemia. Hypoglycemia can occur with some of the oral diabetes medications, too. But insulin does not cause diabetes complications; it's high blood glucose levels that are responsible for complications. Insulin is a helpful and necessary tool in the management of type 2 diabetes.