Can a person with type 2 diabetes ever become insulin dependent?

The answer is yes but it also involves confusing terminology. Type 1 diabetes was, at one time, referred to as “insulin dependent” diabetes as without insulin, patients will become ill and die. Type 2 diabetes was referred to as “non-insulin dependent.”, but there were (and are) many who have type 2 are are treated with insulin. They are not “dependent” on insulin to be alive, but they require insulin for blood glucose control. So very frequently there was confusion among patients and health care workers as to whether any individual adult on insulin was really “dependent” or not. To the patient, they took insulin and therefore thought of themselves as “dependent”, but in the strictest sense, they really were not. So this is in part how the nomenclature of type 1 and type 2 evolved.

Having said that, there are people with Type 2 who on occasion, really become type 1 like in their disease evolution. Sometimes, informally they are called type 1-1/2.

DS
Additional comments from Dr. Stuart Brink:

Yes. The UKPDS documented the increasing need for insulin treatment in type 2 diabetes over time. Seems that the pancreas insulin production decreases over time.

SB
Additional comments from Dr. Donough O’Brien:

In the great majority of people with type 2 diabetes, the fundamental problem is one of insulin resistance as opposed to the insulin deficiency that is the basis of type 1. The need for high serum insulin levels can to a large extent be contained by diet and exercise and by oral hypoglycemic agents that improve insulin sensitivity or reduce the production of glucose from the liver and from muscle glycogen. In time, however, the islet cells in the pancreas are unable to sustain this constant high demand and insulin supplementation may be needed.

DOB