Use insulin as the first-line type 2 diabetes treatment in select patients (1 of 4)

I typically employ this approach in individuals who are newly diagnosed with a glycated hemoglobin (HbA1c) of around 10% (86 mmol/mol; 240 mg/dL). Most people at this level of disease progression have both gluco- and lipotoxicity.

There is no better first pharmacologic option than insulin to help patients regain control and start feeling better quickly. Moreover, in a vast majority of cases where this approach is taken, the patient can be taken off of insulin and allowed to “step down” from this therapy. In giving the news that they do not need insulin anymore, you provide a big psychological victory and allow the patient to reinforce that insulin use can be intermittent and not lifelong once it starts.