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, 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?