“When is a person advised to go on insulin treatment?”

You should not be afraid of taking insulin. It is a safe, effective medication, when used properly, and can be added when a treatment regime is not working well. Your diabetes is clearly not controlled well on your present regime. Speak to your physician to see how he feels about adding insulin.

There is no set # that determines when you start insulin. It depends on many factors such as age, life style, goals of treatment, etc. but a1c of 9% is too high if you want to prevent complications such as neuropathy (nerve damage), heart damage, blindness, kidney damage, foot ulcers, etc. But don't be worried about starting insulin. I have been taking insulin for 26 yrs. With modern insulins, and administration equipment, it is a nothing to take. Needles are so small now you can't feel them going in. The one danger is low blood sugar but careful monitoring of diet, exercise and blood sugar levels this need not be a fear. Blood sugar monitoring is easy now with continuous blood glucose monitors or something like the Freestyle monitor. I can't advise you further since I don't know your age, BMI, medicines you have taken or are taking now. I can only say-Get & keep your blood glucose under control & your A1c below 7% and you will be on the road to preventing the disabling & even deadly complications that come from high BG & high HbA1c.

If the HbA1c is not at goal with non-insulin treatment, diet and exercise, then it is probably necessary to start insulin,

After trying a triple combination of medication for your Diabetes, if the A1c is not below 8, you should go on Insulin