Should I start Insulin if my diabetes is worsening?

Question

Hello doctor,

I am 52 years old and have been living with type 2 diabetes for almost nine years. I have been taking metformin 1000 mg twice daily for a long time, but my last three HbA1c readings were 8.1 %, 8.6 %, and now 9.0 %, showing a gradual increase despite trying my best to follow dietary recommendations.

My endocrinologist recently added Empagliflozin, but I developed a severe urinary tract infection within the first month and had to stop it. My fasting blood sugar is usually around 190 to 220 mg/dL, and post-meal readings sometimes go up to 290 mg/dL.

I am also experiencing numbness and burning sensations in both feet, especially at night, which is affecting my sleep significantly. My kidney function is mildly reduced, with an eGFR of 58 and creatinine of 1.4 mg/dL. Additionally, my eye doctor recently diagnosed mild diabetic retinopathy in my right eye, which was not present during last year’s examination.

I am overweight at 211 pounds and have struggled with losing weight, as it tends to return despite multiple attempts. My cholesterol levels and blood pressure are also not fully controlled.

I am confused about whether it is time to start insulin therapy or if there are other diabetes medications that would be safer, considering my kidney function. I would appreciate your guidance, as my blood sugar levels seem to be worsening over time despite treatment efforts.

Please suggest.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query.

Your blood sugar levels have been rising despite your efforts, and now signs of complications like burning in the feet, early eye changes, and reduced kidney function are appearing. This can feel frustrating, especially when you have been trying to manage your diet and medications for years.

What you are experiencing does not mean you have failed. Type 2 diabetes (a chronic condition where the body either resists insulin or does not produce enough of it, which can cause high blood sugar) often progresses over time, and treatment needs to change as the body’s insulin production declines.

With an HbA1c (hemoglobin A1c)of 9.0 percent, fasting sugars above 190 mg/dL, symptoms of neuropathy, early diabetic retinopathy, and an eGFR (estimated glomerular filtration rate) of 58, it is important to intensify treatment rather than wait.

Starting Insulin is not a punishment or a sign of failure. In many cases, adding a basal insulin at night alongside metformin is a safe and effective way to quickly improve sugar control, especially with mildly reduced kidney function. Another option to discuss with your doctor is a GLP-1 (glucagon-like-peptide-1) receptor agonist (such as Semaglutide or Dulaglutide). These medicines can help lower blood sugar, support weight loss, reduce cardiovascular risk, and generally do not increase UTI (urinary tract infection)risk like Empagliflozin.

The numbness and burning in your feet also deserve attention, as diabetic neuropathy (nerve damage caused by long-term high blood sugar and elevated blood fats in people with diabetes) can worsen over time if sugars remain uncontrolled. Your blood pressure and cholesterol should be managed more aggressively, too, because protecting the kidneys, nerves, eyes, and heart is equally important.

The encouraging part is that acting now can still make a major difference. Early Insulin or GLP-1 therapy may actually improve long-term control and reduce future complications.

I hope this helps.

Please revert in case of further queries.

Thank you.