by DAVID K.MCDONALD
QUESTION: I have diabetes and use insulin. I also take medicines for high blood pressure and an enlarged heart. Can insulin be stopped after taking it for a while, and how safe would that be?
Never stop insulin without a clinician-directed plan. People with type 1 diabetes need ongoing basal insulin to stay alive. Some people with type 2 diabetes can reduce or occasionally stop insulin after severe hyperglycemia improves, after major weight loss or recovery from illness, or when other medicines are added. Others need insulin permanently. Good readings may simply show that the insulin is working, and abrupt withdrawal can cause severe hyperglycemia, dehydration, DKA, or HHS.
Answer by Dr. Albana Greca, MD, MMedSc
Hi David,
The answer depends on the diabetes type, why insulin was started, HbA1c, glucose patterns, kidney function, weight, and the heart diagnosis.
In type 1 diabetes, the pancreas makes little or no insulin. Basal insulin must continue every day, including during illness and poor intake, unless a diabetes specialist gives different instructions. Stopping it can rapidly cause diabetic ketoacidosis.
Insulin may be started temporarily for newly diagnosed severe hyperglycemia, serious illness, surgery, steroid treatment, or when tablets are unsuitable. After glucose improves, the clinician may be able to reduce insulin and use noninsulin treatment.
Long-term insulin may still be needed when the pancreas makes too little, glucose remains high, or alternatives are unsuitable.
Good glucose while taking insulin may mean it is working. Before reducing it, review HbA1c, fasting and after-meal readings, nighttime lows, and CGM data when available. Keep a blood sugar log rather than relying on occasional readings.
For type 2 diabetes, a prescriber may lower one dose at a time while glucose is monitored closely. The plan should include:
Do not skip doses or stop for several days as a test. Review insulin treatment and insulin side effects and hypoglycemia.
“Enlarged heart” is a description, not a complete diagnosis. It may be related to long-standing high blood pressure, valve disease, cardiomyopathy, or heart failure. Ask for the diagnosis, echocardiogram result, and ejection fraction.
For type 2 diabetes with heart failure, treatment should include medicines with proven heart benefit when suitable. Other treatments may support weight or kidney goals and reduce insulin needs, but selection depends on kidney function, blood pressure, dehydration risk, and other medicines.
Do not stop blood-pressure or heart medicines. Diabetes, blood pressure, cholesterol, smoking, weight, and fluid status need coordinated care. See LDL cholesterol and diabetes and diabetes and kidney health.
Reassess insulin after repeated lows, major weight loss, reduced food intake, declining kidney function, difficulty managing injections, or addition of another glucose-lowering medicine. A lower dose or simpler basal-only plan may be safer than complete withdrawal.
Weight and muscle loss, intense thirst, frequent urination, blurred vision, weakness, or very high glucose after stopping treatment can indicate uncontrolled diabetes and require prompt testing.
Encourage same-day medical contact and emergency care for severe symptoms or very high readings. Do not secretly change doses or combine old medicines; sulfonylureas such as glipizide and insulin can cause prolonged hypoglycemia if used incorrectly.
The diabetes medicines guide and type 2 diabetes control guide can help you prepare.
Seek urgent care for persistent glucose around 300 mg/dL or higher, repeated vomiting, abdominal pain, deep or difficult breathing, severe dehydration, ketones, confusion, fainting, chest pain, worsening breathlessness, or rapid swelling and weight gain. Call emergency services for unconsciousness or seizure. Never stop basal insulin in type 1 diabetes.
The goal is not simply to eliminate insulin. It is to use a safe treatment plan that keeps glucose controlled while protecting the heart and kidneys and minimizing hypoglycemia, weight gain, and treatment burden. Some people with type 2 diabetes can reduce insulin safely; type 1 diabetes cannot be managed without it.
Educational safety note: This answer is for general diabetes education only. It does not replace personal medical advice. Do not stop or change insulin, glipizide, blood-pressure medicine, heart medicine, diet, fasting, or exercise without a written plan from the treating healthcare team.
Last reviewed: July 2026.
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