By vgreene, 21 May, 2015 Exclude Patient Type Detail Header No Detail Type Text Detail Text Consider insulin from the outset, w/ or w/o additional agents [E] In any pt w/ A1C ≥9%, consider initiating dual tx (metformin + second agent); insulin more effective as second tx than PO agents If blood glucose ≥300-350 mg/dL and/or A1C ≥10%-12%, esp if catabolic features (wt loss, ketosis) present, consider starting combo injectable tx: Basal insulin + mealtime insulin preferred Patient Type Detail Header (Long) Markedly symptomatic/elevated blood glucose/A1C