The ultimate goal of diabetes management is prevention of long-term complications. An important means to this end is improvement and maintenance of glycemic control over time. Unfortunately, this is not a simple task due to the progressive nature of the disease, which requires timely optimization of treatment, leading in a majority of cases to insulin therapy. Various forces oppose and thus delay starting insulin, and the lag between the time insulin is needed and the time it is used has been described as due to “clinical inertia”
The specific point at which insulin therapy should begin can be difficult to define for an individual person, and universal guidance has proved elusive.
However, suggestion of a need to increase self-monitoring, and thus finger pricking, to support optimization of insulin have ameliorated injection problems to some degree. Finally, educational support for starting injections and adjusting the dosage of insulin is not easily available to all people. This discussion clearly demonstrates that despite its long history, much remains to be learned about the best ways to use insulin therapy, which continues to be centrally important in the management of type 2 diabetes.