I believe what you are asking is "over time how many will end up on insulin" and I don't even know how to research that question.

According to the CDC "at the moment" (or whenever they did this data pull) - and this is all Type 2 stats:

14% are on Insulin
13% are on insulin and another oral diabetes med
57% are on (non-insulin) diabetes meds
16% are no meds at all

But this is a "snap shot".

Because Type 2 is Metabolic there is probably no "carved in stone" projection of where YOU or I will be in 20 years. Even if we are the same age, diagnosed at the same time and both lived to life expectancy, we would probably still have (different) diabetes.

If I think of my immediate family that is no longer walking the earth that was type 2, there was 16 of them. Only 4 of them (25%) were ever on insulin - one of them was my father.

My Great Grandfather was diagnosed when he was 50 years old and died of "unrelated causes" NOT on insulin or any meds for that matter at age 101. My Grandmother diagnosed at age 60, went on the "newly approved magic diabetes med "metformin" (about 1970 in Canada), was off it four or five years later and died of cancer, unrelated to her diabetes in 1980. I had five other aunts, two uncles, a couple grandparents on the other side and a few first cousins that have all passed on, none ever on insulin, and none of them died from diabetes related causes.

On the other side of things, the four relatives that were on insulin all died of complications. Two uncles, one missing a foot the other an entire leg died of heart failure. An aunt died of kidney disease and my father died of congestive heart failure about a day or two before he would have died of kidney disease.

One personal note here. My father made me look like an amateur in terms of diet, tracking and analyzing what I eat etc and he still ended up on insulin. So I don't believe you can "prevent it" if you are (destined) to progress. But I absolutely believe, no matter how far "your diabetes" is going to progress, you can significantly delay it by being vigilant. I may end up on insulin one day, but it won't be because I threw in the towel and abdicated my care to meds. If/when I need it I want to know that "I" did everything I could "first".

So, only anecdotal, but if "my cluster" is representative, I would say your odds are about 1:4

It all depends on how your pancreas can supply insulin itself. Type 2 diabetes often starts off as insulin resistance, we still produce some insulin but our bodies do not utilize it well. Insulin's role is to pull sugar from blood circulation and put the sugar into our cells to nourish them. After a while the pancreas can no longer keep up the insulin production, some people stop producing insulin altogether which is when insulin injections come into play.

Diabetes is a progressive disease with episodes of remission when we change our lifestyle and diet, but eventually your body will no longer use or produce insulin. So people end up on insulin or they risk going into DKA (diabetic Ketoacidosis). So ending up on insulin for some is just the progression of the disease, for others it is the non compliance with diet changes. There is no cure for diabetes but there are medications that can help. So as long as you can manage diabetes with dietary changes, drinking water, exercise if possible, you can postpone having to go on insulin, but some people it is a question of genes and if other people in the family have diabetes you might not be able to control it through nutrition after time. So for as long as you can control with dietary changes, it is to your advantage.

Drinking water prevents dehydration, has no sugar and helps dilute your sugar levels. Going on insulin does not mean someone did something wrong, it could be their pancreas that no longer produces insulin.

Type 1 diabetics have an autoimmune disorder and this is why they are on insulin as they do not produce insulin, this is also why it is often discovered in childhood or below age 30, they might have produced some insulin at some point, but no longer will over time, pill form medications do not work on Type 1 diabetic.

So if you are type 2 you have an advantage of trying to control your sugar levels with diet. But remaining hydrated is also important. When your body senses there is no sugar in your cells, the liver releases sugar into the bloodstream, which then increases sugar levels as this sugar stays in the blood rather then nourish your cell, so your liver might try and release even more sugar hoping your cells get some to function, so now you are in a vicious circle, so insulin becomes a treatment.

Thank you Graham. You have great knowledge and it is appreciated. Like any disease you may have all knowledge is important.

Thank you. Do you know what percentage this is that eventually go on insulin?