Is it OK to start insulin for managing diabetes?

Q: My son is 21 years old and has been diagnosed as diabetic with sugar levels 275 (fasting) and 474 (PP). He has been advised to take insulin 20 units twice a day. My wife is type 2 diabetic since 15 years and I too have sugar levels higher than normal. What could be the cause of my son having diabetes - genetic or some other reason? Is it alright to straight away start with insulin and if sugar levels come down, will the insulin be stopped? Will he remain diabetic all his life? Can antibiotics cause diabetes?

A:1) As both the parents are diabetic, in your son's case, genetics seems to have played a big role in causation of DM. As such Indians are genetically more predisposed to DM and whenever there is change in lifestyle i.e., sedentary lifestyle habits and fast food, etc the diabetes become overt. 2) With such a high levels of glucose it is ok to start with insulin.3) Now whether we can stop insulin in your son's case or not depends upon what is the type of DM. In majority of cases DM is either type 1 or type 2. If your son is obese, does not have much symptoms of DM i.e., increased urine output, increased thirst, increased appetite, and recent weight loss then this will suggest that he has type 2 DM and once sugar is controlled he can very well switch over to oral medications or from the beginning he can take both medications and insulin. If he is thin, has significant diabetic symptoms or urine is positive for ketones (initial one) then he is likely to have type 1 DM and in this situation insulin will be required lifelong. Lab tests which can differentiate between these two types are antibody tests i.e., Anti-DAD or Anti-IA2 antibodies. These tests are not easily available and are expensive.4) He will remain diabetic lifelong but in case it is type 2 DM, then, if he follows diet and exercise as advised, there are good chances that he can go into remission; meaning without DM for variable period, months to years, during which he may not need any medication but has to continue with diet and exercise.5) No, antibiotics do not cause DM.