Type 2 diabetes is a metabolic state of high blood glucose mostly caused by insulin Resistance and relative insulin insufficiency. Unlike type 1 diabetes (absolute insulin deficiency), it may take long time to evolve into full blown symptomatic diabetes. The initial treatment is diet, exercise, and weight loss. If blood sugars are not normal, then oral medications are introduced; insulin sensitizers, mainly Metformin, are started. If blood sugar is not controlled (HA1c <7.0), then a 2nd, 3rd, etc., oral medications with a different mechanism of action is also introduced depending on the individual response. If blood sugars are not controlled with all these medications and HA1c stays above 8%, then long-acting insulin is introduced besides the oral medications. If HA1c stays above 8%, then meal times short-acting insulin are required and adjusted to bring the blood glucose to a desired goal between 70-140 mg/dl (HA1c <7%). If blood sugars on oral medications are above the desired range, then insulin should be introduced, at least long-acting insulin either daily or twice a day depending on the individuals situation. In case of abnormal kidney function, oral medications should be lowered or stopped. In this scenario, insulin is the way to go. High blood pressure and abnormal lipids should be aggressively treated. Also, any diabetic patient with HA1c of >7% persistently should consider treatment with statins (cholesterol medications) to protect the heart regardless of there cholesterol level in the blood.
Remember, medicine is an art. Doctors may practice medicine slightly different regardless of guidelines or evidence based medicine. So, expect some differences among practitioners. This should not be seen as bad or good. Just normal variations. This is general advice but does not substitute your doctor's advice. Please discuss it with your doctor as well.