Starting Insulin Earlier Rather Than Later
Reviewed by CDE Mehandi Sharma · Updated
In Type 2 diabetes insulin is usually the last step, reached after other options are exhausted. In LADA the thinking is different, and often the opposite.
The reasoning is that your beta cells are failing because they are under immune attack, and high blood sugar makes that worse — a strain sometimes called glucose toxicity. Supplying insulin from outside lowers the demand on those cells and lets them work less hard.
Studies in LADA have found that insulin treatment is associated with better preserved insulin production, a better response when the pancreas is tested, and slower progression to full insulin dependence than treatment with sulfonylureas.
Two common fears are worth naming directly.
- "Starting insulin means I have reached the end." In LADA it usually means the opposite — it is a step taken to protect what remains, not a last resort.
- "Once I start, I can never stop." In LADA that is broadly true, but not because insulin is addictive. It is because your own production keeps falling. The insulin is replacing something genuinely missing.
In practice, starting usually means one injection of long-acting insulin a day, often at bedtime, at a small dose that is adjusted over a few weeks using your fasting readings. Mealtime insulin comes later, if and when it is needed.
The decision is made with your doctor, informed by your C-peptide level and how your control is trending.