By rray, 21 December, 2023 Exclude Patient Type Detail Header No Detail Type Text Detail Text Consider initiation of insulin regardless of background glucose lowering tx or dz stage if there s evidence of ongoing catabolism e g unexpected wt loss if sx of hyperglycemia are present or when A1C or blood glucose levels are very high i e A1C 10 or blo In adults w T2DM a GLP 1 RA including a dual GIP GLP 1 RA is preferred to insulin A If insulin is used combo tx w a GLP 1 RA including a dual GIP GLP 1 RA is recommended for greater glycemic effectiveness as well as beneficial effects on wt and hypoglycemia risk Reassess insulin dosing upon addition or dose escalation of a GLP 1 RA or du Glucose lowering agents may be continued upon initiation of insulin tx unless contraindicated or not tolerated for ongoing glycemic and metabolic benefits i e wt cardiometabolic or kidney benefits A To minimize risk of hypoglycemia and tx burden when starting insulin tx reassess the need for and or dose of glucose lowering agents w higher hypoglycemia risk i e SUs and meglitinides A Monitor for signs of overbasalization during insulin tx such as basal dose exceeding 0 5 units kg day significant bedtime to morning or postprandial to preprandial glucose differential occurrences of hypoglycemia aware or unaware and high glycemic variabi Patient Type Detail Header (Long) Insulin tx considerations