What is the primary indicator for starting insulin therapy in type 2 diabetes?

The primary indicator for starting insulin therapy in type 2 diabetes is severe hyperglycemia despite the use of oral medications. When patients with type 2 diabetes fail to achieve adequate glycemic control with oral hypoglycemic agents, typically indicated by persistently elevated blood glucose levels, initiating insulin therapy becomes necessary. Insulin acts as a powerful means to lower blood glucose levels effectively.

In patients who are unable to achieve target glycemic levels with lifestyle modifications and medication regimens, insulin provides an alternative therapeutic approach that directly addresses the insulin deficiency or resistance present in type 2 diabetes. It is particularly indicated in situations where blood glucose levels are significantly high, often considered as fasting blood glucose levels above 250 mg/dL or A1C levels above 10% in many clinical guidelines.

Other factors mentioned, such as poor dietary adherence, can certainly affect glycemic control but do not directly warrant the initiation of insulin therapy unless severe hyperglycemia persists. The presence of ketones in urine may signify insufficient insulin but is more of an indicator of diabetic ketoacidosis, which is more common in type 1 diabetes. Uncontrolled hypertension is a significant health concern in diabetes but does not specifically dictate the need for insulin therapy based on glycemic control alone. Thus