Insulin initiation: bringing objectivity to choice

The choice of initial insulin is often dictated by subjective criteria: the "severity" of diabetes, the ability of the person with diabetes to self inject, at specific times of the day, and the physician's personal experience. No objective criteria have been evolved by any expert body so far to help guide clinicians make an appropriate, and accurate, choice of initiating insulin. Neither have large studies been able to shed light on the preferred type of insulin regime for a particular individual. This communication suggests various objective parameters which may be used to inform this decision.