Insulin is a hormone secreted by Beta – Cells of pancreas. People with Type 1 DM require insulin throughout their life to manage their blood sugar as their body produces no insulin or very little insulin. In T2DM, insulin is required when people with diabetes (PWD) on oral drugs, fail to adequately control blood glucose or when they present with severe symptomatic hyperglycaemia (where FBG > 250mg & or PPBG > 350mg/dl or GHb- >9-10 % along with symptoms) to reduce beta cell exhaustion & glucose toxicity. It can be given in combination with metformin. It is a temporary condition & insulin can be stopped, once noromoglycemia is achieved in case of Type 2 DM.

Insulin remains the drug of choice during major surgery or in presence of any infection or during any acute illness. 20-30% of T2DM may required insulin within 3 years of diagnosis of diabetes, as they fail to respond to oral drugs, and almost 90% will fail to respond to the maximum dose of oral glucose therapy in 14-16 years duration of diabetes. Importantly, most of the people will need insulin sooner or later in the natural course of T2DM. Insulin therapy can be used alone or in combination with oral drugs to maintain normoglycaemia. Insulin is the best drug of choice in diabetes management. (Recorded 22nd Sept 2023)