nitiate insulin at any time if patients have symptoms of insulin deficiency, e.g. weight loss, polyuria, polydipsia, and consider starting insulin at any time if the HbA1c is > 10%.

People with type 2 diabetes who have symptoms of insulin deficiency or HbA1c >10%

Initiate insulin immediately for insulin-deficiency symptoms and consider insulin for HbA1c >10%

Continued non-insulin glucose-lowering therapy alone

Relief of insulin-deficiency symptoms and achievement of glycemic target