Table 1.
When and in whom to initiate insulin in T2D
| When to consider insulin initiation | When NOT to initiate insulin |
|---|---|
| Maximally tolerated non-insulin agents but A1C above the individualized target (usually 7.0%) New diagnosis A1C ≥ 8.5% Metabolic decompensation End-organ failure Patients with previous or current gestational diabetes Acute illness Prolonged course of steroids Intolerance to oral medications Any time you consider this is an appropriate option for your patients from diagnosis onwards |
There are no contraindications for the use of insulin but insulin may not be appropriate for: Some older, asymptomatic patients, who may not gain sufficient benefit because of short life expectancy People limited in their capacity (physical or cognitive) to manage their diabetes who are at greater risk of hypoglycemia |