Two years ago, my 50 year old husband was diagnosed as having type 2 diabetes which was controlled by diet and exercise for a year. For the last year, he has he been taking oral medication, but his doctor has said my husband will need to go on insulin in about six months.

My husband feels fit, well (but tired) and is reluctant to go onto insulin as he never suffers any bad effects. He will lose his Heavy Goods Driving license if he goes on insulin, and this is his livelihood and the job he loves. He can not understand why he needs insulin, and the doctor has not really explained it other than to protect vital organs. If my husband feels so well with no bad symptoms, how can anyone tell when is the right time to commence insulin?

I think your husband’s doctor suspects that he might be actually have a form of autoimmune diabetes called Late-onset Autoimmune Diabetes of Adulthood (LADA) in which the clinical picture of diabetes at onset might be indicative of type�2. LADA is actually a slowly evolving form of autoimmune destruction of the pancreatic beta cells resulting in insulin dependency over a variable period of time after the initial diagnosis. This must be confirmed through the evaluation of the presence of antibodies against beta cells, particularly GAD.

During the initial phase of LADA, diet and exercise may control the metabolic situation very well, and insulin need may be not seem logical from the patient’s point of view. The rationale behind this hypothetical need for a precocious starting of the insulin therapy is the preservation of endogenous secretion in order to prevent chronic complications and to avoid late need for multiple insulin injections.

MS

[Editor’s comment: If the doctor can’t convince your husband of the appropriateness of the recommendation, I’d advise getting a second opinion.

WWQ]