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If you have type 1 diabetes, there is currently no way to avoid taking insulin injections. Type 1 diabetes develops when the body's disease fighting system — the immune system — destroys all your body's insulin-producing cells. Insulin is a vital hormone that your body needs to convert food into energy. If your body is producing no insulin, you must take it by injection to live. Insulin currently cannot be taken by mouth because the digestive juices in your stomach and intestine will break down the insulin before it has a chance to get into your bloodstream to do its job.
If you have type 2 diabetes, you may or may not have to take insulin injections, depending on a variety of factors. People diagnosed with type 2 diabetes in general are still producing some insulin, although the amount they produce is not enough for their needs. Their cells may also be resistant to the effects of insulin, which makes them need more insulin than a person who does not have diabetes. Frequently when type 2 diabetes is diagnosed, weight loss, exercise, and changes in how much you eat can bring blood glucose levels back into a normal range without the use of any medications. Exercise and weight loss are particularly helpful in decreasing insulin resistance.
Sometimes people initially diagnosed with type 2 diabetes are very overweight and have not been getting enough physical activity. Their blood glucose is so far out of control that their healthcare team starts them out on insulin just to get things under control. If the person then loses weight and begins a regular exercise program, insulin injections may become unnecessary.
Sometimes oral diabetes medications — these are not insulin! — are needed to help your body use the insulin being produced better, or to help your body produce more insulin. In the last few years, a wide variety of different types of oral diabetes medications have been developed that work in different ways. Sometimes one type of medication will work well for you for a period of time, and then your blood glucose will begin to get out of control again. At that point, your healthcare team may switch to another type of medication, or add a second medication to the one you are already taking. This, combined with weight control and regular exercise, may help you continue to avoid using insulin injections.
People who have had type 2 diabetes for many years may ultimately discover that despite their best efforts, the oral medications, diet and exercise alone no longer seem to keep their blood glucose in a healthy range. This is not unusual. One theory is that your insulin-producing cells may just be tired out from having to produce extra insulin to overcome insulin resistance over all these years. At this point, insulin injections may be required to continue to keep your blood glucose in the healthy range to avoid longterm diabetes complications.
There is a lot written in the lay press about oral insulin, nasal insulin sprays, or even transplanting insulin-producing cells as ways to help people with diabetes no longer have to inject insulin to control their diabetes. While these are exciting areas of research, none of these products are currently available for use by the general public.
Find more information about diabetes in What You Need to Know about Diabetes – A Short Guide available from the Joslin Online Store. | 
