Patient resistance to insulin therapy may be due to feelings of failure

In type 1 diabetes, the body is unable to produce insulin for glucose control so regular administration of insulin is the main treatment. In type 2 diabetes, insulin secretion may be elevated but still inadequate to control glucose. Insulin therapy is not required initially but may be required later as glucose metabolism deteriorates. Insulin is indicated when there is inadequate control of blood glucose on oral hypoglycaemic drugs or in acute episodes such as myocardial infarction where survival rates are improved when patients are treated with insulin. The failure of insulin secretion in type 2 diabetes is progressive, falling from 50 per cent of normal at diagnosis to 25 per cent after six years. Patients may feel that insulin treatment signifies that they have failed in adhering to lifestyle and dietary advice.