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Insulin initiation in type 2 diabetes — SCE Endocrinology MCQ

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ModerateDiabetesInsulin initiation in type 2 diabetesSCE Endocrinology

A 59-year-old woman with type 2 diabetes has HbA1c 75 mmol/mol despite metformin, empagliflozin and semaglutide. BMI is 36 kg/m2. She has symptomatic hyperglycaemia with nocturia and weight loss. What is the most appropriate management?

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Correct answer: C — Start basal insulin while continuing cardiorenal protective therapy where tolerated

Symptomatic hyperglycaemia despite multi-drug therapy warrants insulin initiation, usually basal insulin first in type 2 diabetes. Cardiorenal protective agents may often continue if tolerated and safe. Acarbose is unlikely to be sufficient in catabolic symptomatic hyperglycaemia.

Reference: NICE NG28; BNF