Why was insulin discontinued in a patient who still consumes three meals a day?

Why Insulin Was Discontinued Despite Regular Meals

Your mother's insulin was likely discontinued because her blood sugar control improved sufficiently to no longer require it, which is a medically appropriate and increasingly common practice in type 2 diabetes management. 1

Most Common Reasons for Insulin Discontinuation

In a large real-world study of over 7,000 patients with type 2 diabetes, 42% discontinued insulin within 12 months, and the most frequent reasons were 1:

• Improved blood glucose control (33.2% of cases) - Her diabetes may now be well-controlled through diet, weight loss, or other medications 1
• Achieved weight loss (18.5% of cases) - Weight reduction can dramatically improve insulin sensitivity and reduce or eliminate insulin requirements 1
• Starting non-insulin diabetes medications (16.7% of cases) - Newer medications like GLP-1 receptor agonists (Victoza, Ozempic) or SGLT2 inhibitors (Jardiance, Farxiga) may have replaced her insulin need 1

Why Eating Three Meals Daily Doesn't Mean Insulin Is Required

The number of meals consumed does not determine insulin necessity - what matters is overall blood sugar control and the body's ability to manage glucose. 2

• For patients with type 2 diabetes not taking insulin, a simple approach emphasizing portion control and healthy food choices is often sufficient for glycemic management 2
• Consistent meal patterns help with blood sugar stability, but insulin is only needed when the body cannot adequately control glucose through its own production or with oral/injectable non-insulin medications 2
• Many patients with type 2 diabetes can achieve excellent control through diet modification, weight loss, and non-insulin medications without requiring insulin therapy 1

Clinical Factors That Support Insulin Discontinuation

Patients are appropriate candidates for stopping insulin when they demonstrate 1, 3:

• Disappearance of diabetic symptoms (excessive thirst, urination, fatigue) 3
• Daily insulin requirement drops below 0.25 units/kg body weight 3
• Achievement of normal fasting and post-meal blood sugar levels 3
• Better preserved beta-cell function (the pancreas's ability to produce insulin) 3

Who Makes These Decisions

Patients seeing endocrinologists (diabetes specialists) are 2.6 times more likely to have insulin appropriately discontinued compared to those seeing only primary care physicians. 1 This suggests your mother's medical team made a deliberate, evidence-based decision rather than an error.

Important Monitoring After Insulin Discontinuation

Her healthcare team should be 2:

• Monitoring her A1C levels every 3 months to ensure continued good control 2
• Checking fasting and post-meal blood sugars periodically 2
• Adjusting her current medications (if any) to maintain blood sugar targets 2
• Watching for return of diabetic symptoms that would indicate need to restart treatment 3

Common Pitfalls to Avoid

The key concern is ensuring she maintains adequate glucose control without insulin. 1 Warning signs that would require medical attention include:

• Return of excessive thirst, urination, or unexplained weight loss 3
• Blood sugar readings consistently above 180 mg/dL 4
• Development of diabetic symptoms like blurred vision or slow-healing wounds 3

This discontinuation represents therapeutic success, not abandonment of care - it means her diabetes is better controlled now than when she required insulin. 1