Coming Off Insulin After a Diagnosis
Reviewed by CDE Mehandi Sharma · Updated
Being told you may be able to stop insulin after years of injections is a genuinely strange experience, and it is a real possibility in some subtypes.
In the UK study, 73.5% of people diagnosed with HNF1A or HNF4A-MODY changed treatment afterwards. Among those with GCK-MODY, eight of nine stopped diabetes treatment altogether.
What predicted success, in those aiming for sulfonylurea or diet alone, is worth knowing because it is not random:
- Shorter diabetes duration — a median of 4.6 years in those who succeeded, against 18.1 years in those who did not.
- Lower HbA1c at the point of change — about 7.5% versus 8.8%.
- Lower BMI — a median of 24.2 against 26.0.
The duration finding is the most consequential. It means the earlier the genetic diagnosis is made, the better the chance of coming off insulin — which is an argument for testing sooner rather than eventually.
It also means a longer-standing diagnosis does not rule out a change; it lowers the odds. Success in the study was 62% among those who tried.
How it is done: gradually, with a sulfonylurea introduced at low dose while insulin is reduced, with frequent glucose monitoring and clear instructions on what to do if readings rise or you go low.