I commonly come across patients presenting to me with blood sugars which are quite high (FBS > 200 mg/dl). Talking to them, I realize that they were detected to have mild to moderate elevation in blood sugars (130-140 mg/dl), which they tried managing with diet and exercise and then gave it up. It later was ignored and now they turned up with weight loss, frequent urination and tiredness.
We have to think of this condition as beyond the routine diabetes that we come across. This is a subject with significant deficiency of insulin with derangement of fat and protein metabolism in addition to carbohydrate metabolism. The beta cells of the pancreas which secrete insulin are suppressed due to high sugars (it is called glucotoxicity).
The best solution for this problem is insulin. Insulin can correct the insulin deficiency and relieve the glucotoxicity. This helps the insulin producing beta cells to get active and produce insulin. In the due course of time, insulin can be stopped and the subject can start using oral anti diabetic drugs. Studies have shown that when insulin is started at diagnosis, subjects tend to have better function of the beta cells 1 year later.