As already said on the whole people with T2 have insulin resistance to throw into the mix. They may also still be making a considerable amount of their own insulin. Some T2s take a lot of insulin compared with most T1s. (sometimes hundreds of units, by comparison I take 20-25 units which is towards the lower end for T1)
Sometimes insulin in T2 is just used as a supplement ; quite often people get prescribed a background insulin like lantus which may work well in combination with other medications,
If that doesn't work well T2s in the UK seem most normally to be put onto mixed insulin regimes; with 2-3 injections a day (again often with additional oral meds).
They seem less likely to be moved to basal bolus regimes (4+ injections of separate longterm and mealtime insulins) than people with T1.
You can't do a DAFNE course in the UK if you are a T2 on insulin and the reason given is:
"There is no evidence that intensive insulin therapy is of benefit for people with Type 2 diabetes."
Intensive in this case means dose adjustment for a 'normal' diet as opposed to conventional treatment which relies on fixed doses of insulin (and really ought to be tied to fixed amounts of carbohydrates). The fact that a person with T2 may be producing some insulin of their own and that they may have insulin resistance is thought to make this type of 'therapy' less effective.
Nevertheless I've met type 2s online who use 'intensive' insulin therapy, I've met some who use pumps and some of these people have very good control. One man who is quite a prominent T2 pumper on forums has written a book about sucessful T2 management. He started on oral medication, and was on oral medications for 12 years. At the end of this periods his HbA1cs went from 6% to over 8%, he then moved onto lantus, then a mixed insulin and eventually a pump. Since going on the pump in 2007, he has had no HbA1c greater than 5.7%, his latest are down as low as 5%. He still takes metformin to counter insulin resistance in the shape of too much glucose from the liver: Intensive therapy works for him
Having said all that: T2 is a big catchall category, it includes a range from those who are insulin deficient to those who produce plenty. It includes those who are only mildly insulin resistant (and we probably all get more insulin resistant as we age) to those who are extremely resistant. It often includes people who have an autoimmune attack but are miss diagnosed because of their age.
On top of this there are a great many very different causes for diabetes from drug induced, for known genetic reasons, because they've had a particular illness, because the have too much iron etc etc. These people are not T2 but are often lumped into the T2 category when they shouldn't be, In the UK there seems to be only 2 boxes on the computer!
WIth all these different types of diabetes shoved into a T2 box, there will be some who have not enough insulin to sustain life so will be just like T1s. There will be others who produce it, but not enough to overcome insulin resistance so need insulin to supplement their own..
