Ask Diabetes Health

I am a 35-year-old female. I have recently been diagnosed with Type 2 Diabetes and have been started with insulin. Will I be on insulin for life- long? Type 2 Diabetes develops in an individual when the body becomes resistant to Insulin or when the pancreas stops producing enough insulin. In Type 2 Diabetes usually, treatment is started with diet, exercise, oral hypoglycemic agents and if required, insulin. However, insulin is prescribed early in Type 2 Diabetes if HbA1c is more than 10 per cent or when oral medications fail to reduce the blood sugar levels.

Studies have shown that early insulin therapy in Type 2 Diabetes helps preserve the beta cells of the pancreas, prevent the complications of Diabetes and improve Insulin resistance, thus providing better blood sugar control for many people.

Sometimes in Type 2 Diabetes, after a short period of insulin treatment, if a person follows an intensive diet control and exercise, it is possible to reduce the insulin dosage and maintain blood sugar levels with oral drugs.

It is difficult to conclusively opine whether insulin administration in your case is life- long. Therefore, it is advised to consult your physician, follow an appropriate diet, start physical exercise and monitor your blood sugar levels. By following your physician's advice, there may be a possibility to reduce your insulin dosage and optimise your oral medications for Diabetes. However, it is to be remembered that insulin is a safe and effective medicine for Type 2 Diabetes.

Insulin administration is also advised in women with Type 2 Diabetes who are pregnant. Please note that in some cases of Type 2 Diabetes where there is a complete deficiency of insulin production in the body and in Type 1 Diabetes, insulin administration is the only way to manage blood sugar levels.

Dr Manish Bothale

Consultant Physician

I am 50 years old. I have been diagnosed with Type 2 Diabetes for 5 years now. Why is blood sugar control necessary prior to an elective surgery?

In general, people with Diabetes undergo certain procedures and surgeries more commonly than people without Diabetes. They often require frequent and longer duration of hospitalisation which results in increased expenses than people without Diabetes. Preoperative hyperglycaemia (high blood sugar levels before a surgery) increases the risk of death by heart attack, impairment of the nervous system, secondary infection and other post-surgery complications. More than one-third of people who are scheduled for any surgery remain unrecognised of their Diabetes status. Hence, diagnosis of Diabetes prior to a surgery is necessary. Haemoglobin A1c (HbA1c) is a suitable screening test to diagnose people whether they have Diabetes, before a surgery.

Surgical procedures may result in a number of metabolic changes that can alter the way body processes glucose. This results in high blood sugar levels in the body which is a risk factor for post-surgery infection in the blood and surgical site, impaired wound healing and delayed recovery.

Complications from surgical wounds are more common in people with Diabetes and healing is impaired when blood sugar levels are not managed well.

In addition to this, surgery-related stress results in increased production of stress hormones like cortisol and catecholamine which reduce insulin sensitivity and lead to diabetic ketoacidosis or coma. Screening for Diabetes-related complications like neuropathy, nephropathy, retinopathy and heart disease is necessary to stabilise a person with Diabetes before any surgical procedure. If any complication arises due to high blood sugar levels, then the surgery should be postponed to a later date.

If a person is taking oral Diabetes medication, then it has to be stopped before the planned surgical procedure and patient has to be taken on insulin. In addition to this, surgery-related stress results in increased production of stress hormones like cortisol and catecholamine which reduce insulin sensitivity and lead to diabetic ketoacidosis or coma. Screening for Diabetes-related complications like neuropathy, nephropathy, retinopathy and heart disease is necessary to stabilise a person with Diabetes before any surgical procedure. If any complication arises due to high blood sugar levels, then the surgery should be postponed to a later date.

If a person is taking oral Diabetes medication, then it has to be stopped before the planned surgical procedure and the patient is taken on insulin injection according to requirements to target blood sugar level of 80-180 mg/dL. The best choices are rapid and long-acting insulin in the form of continuous intravenous infusion or basal-bolus regimen.

Dr Prashant Bhalekar

Consultant Physician