I didn't know type 2 diabetes required insulin. I thought that was for Type 1. She must be in very poor health. I hope she does not suffer or too long before leaving this mortal coil.
In early stages, I think Type 2 is often controllable by meds. Insulin starts being used when meds are no longer working.
Putting all the pieces together, Pam was probably very obese and "pre-diabetic", but either did not visit her doctor or disregarded his warnings. One she was in Type 2, either she still did not see her doctor, or in some way did not follow her doctor's instructions (meds and/or diet). Now her knife, fork, spoon, and inactivity have her on the insulin tightrope. Before and early into Type 2, she probably could have backed out by cutting carbs, increasing protein, reducing portions, and an extra mile or two of daily walking. Now she has to balance diet, activity,
and blood sugar vs. insulin (if either get too high she will need to head for the ER).