Starting Insulin: A Framework for New Clinicians

Insulin initiation is one of the most emotionally charged conversations in diabetes care. Patients often see it as failure. Frame it as progression, not defeat. Start with basal insulin — typically 10 units at bedtime, or 0.1–0.2 units/kg. Titrate by 2 units every three days until the fasting target is met. Hypoglycaemia is the rate-limiting adverse effect. Teach patients to recognise it, treat it with 15g of glucose, and adjust doses accordingly. Revisit the regimen at every visit. Insulin needs change with weight, activity, and comorbidities. A static prescription is rarely the right one.