Does starting insulin in a patient with type 2 diabetes implicate lifelong insulin treatment?
René Rodríguez-Gutiérrez, MD: For sure not. I think there are some scenarios, for instance, during hospitalization, when you have to use insulin, and once the patient is out, often he or she can go on without insulin. There are some other times where you have to use it, for example, early when the hemoglobin A1c level in a patient with diabetic syndrome is very high, then insulin can be started. But once glucotoxicity and lipotoxicity go away from beta cells, then you can lower the dose and often go off insulin.
The other scenario where it is common to use insulin for a while is, for example, myocardial infarction, pancreatitis, or an acute infection that increases insulin resistance. It may be used in that scenario in an ambulatory setting for some time, but in the end the patient can go off insulin.