Type 1 Diabetes and Insulin Non-Negotiability: What Happens When Injections Stop

For people living with Type 1 diabetes, insulin is not optional—it is a life-sustaining treatment. A recent case shared by an internal medicine specialist has highlighted the potentially fatal consequences of stopping insulin therapy after a 26-year-old man reportedly died from diabetic ketoacidosis (DKA) after replacing his prescribed insulin with oral diabetes medication. The case was shared on X by Dr Priyam Bordoloi, an internal medicine specialist from Assam. According to the doctor, the man had been diagnosed with Type 1 diabetes during his teenage years but became frustrated with taking daily insulin injections.

He reportedly stopped using insulin and instead began taking oral diabetes pills borrowed from a relative, believing they could serve as a substitute. However, oral medications used to treat diabetes are not designed to replace insulin in people with Type 1 diabetes. By the time the patient reached the hospital, his condition had deteriorated significantly. According to the account, he was unresponsive, his blood glucose level had exceeded 600 mg/dL, he was breathing deeply and rapidly, and his breath had a distinctive fruity odour—classic signs of diabetic ketoacidosis (DKA), a medical emergency caused by a severe lack of insulin. Despite medical intervention, the patient could not be saved.

Explaining the condition, Dr Rajiv Kovil, Diabetes and Obesity Specialist at Zandra Healthcare, said insulin is essential for people with Type 1 diabetes because their pancreas produces little or no insulin. Without it, the body cannot use glucose for energy and begins breaking down fat instead. This process leads to the production of acidic compounds called ketones, which accumulate in the bloodstream and can rapidly result in DKA if not treated promptly. DKA can develop within hours of missing insulin doses and is characterised by persistently high blood sugar, excessive thirst, frequent urination, nausea, vomiting, abdominal pain, deep and rapid breathing, fruity-smelling breath, confusion and, in severe cases, unconsciousness.

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It requires immediate hospital treatment, including intravenous fluids, insulin therapy and correction of electrolyte imbalances. Delayed treatment can lead to organ failure, coma and death. Doctors emphasise that Type 1 diabetes and Type 2 diabetes require different treatment approaches. While many people with Type 2 diabetes can manage their condition with oral medications, lifestyle changes or insulin, people with Type 1 diabetes depend on insulin for survival because their bodies cannot produce the hormone. Oral diabetes medications cannot replace insulin in these patients, and switching medications without medical advice can have life-threatening consequences. Healthcare experts also caution against using medicines prescribed to someone else, even if they appear to treat the same condition.

Diabetes treatment is individualised based on the type of diabetes, blood sugar levels and overall health.  Any changes to insulin dosage or medication should only be made under the supervision of a qualified healthcare professional. The case serves as a stark reminder of the importance of adherence to prescribed insulin therapy and recognising the early warning signs of DKA. People with Type 1 diabetes are advised to seek immediate medical attention if they experience symptoms such as persistent vomiting, difficulty breathing, confusion or very high blood sugar levels, as prompt treatment can be lifesaving.

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