The decision to start insulin therapy requires frank dialogue with a patient about lifestyle, psychosocial, and employment matters. Given this patient's particulars, what type of insulin would you prescribe and on what schedule?
The patient is a 53-year-old African American with type 2 diabetes, in the clinic for regular follow-up. His blood pressure and weight down slightly from his last visit, but his new symptoms cause you concern.
The patient, an active 49-year-old man, had an HbA1c of 8.6 after diabetes was first diagnosed. It’s now 7.6 with metformin and lifestyle measures. Is the current A1c goal adequate, or should you treat more aggressively?