In this third episode, Dr Tebelele and Dr Mashitisho build on the foundations of diabetes diagnosis and patient identification to focus on insulin therapy — specifically the selection and optimisation of basal insulin options. The discussion demystifies the various insulin generations, clarifies pharmacokinetic profiles, and highlights how choosing the right basal insulin can dramatically improve glycaemic control while reducing hypoglycaemia risk.

Through relatable clinical scenarios, the speakers provide practical cues for initiating, titrating, and individualising insulin therapy in the primary-care environment. The conversation places strong emphasis on patient education, simplified regimens, and confidence building among clinicians who manage diabetes daily.

1. Distinguish between basal, bolus, premixed, and newer analogue insulins.
2. Describe pharmacological differences among basal insulins (NPH, glargine, detemir, degludec) and their clinical implications.
3. Identify patient characteristics that guide the selection of an appropriate basal insulin.
4. Apply principles of insulin initiation and titration safely in outpatient practice.
5. Counsel patients effectively to promote adherence and address fears surrounding insulin therapy.

• Select and justify the use of an appropriate basal insulin based on patient profile and resource setting.
• Optimise insulin regimens to achieve target HbA1c while minimising hypoglycaemia.
• Implement step-by-step titration algorithms with patient involvement.
• Recognise and manage barriers to insulin initiation, including misconceptions and stigma.
• Contributes to a multidisciplinary approach for sustainable diabetes control.

• Generations of insulin: From human and NPH formulations to modern long-acting analogues that provide stable 24-hour coverage.
• Pharmacological distinctions: Comparison of onset, peak, and duration across basal types; importance of flat, predictable profiles for reduced nocturnal hypoglycaemia.
• Patient-centred selection: Considering lifestyle, comorbidities, cost, and convenience when choosing basal insulin.
• Clinical practice tips: Start low, titrate slow, and educate — empower patients to self-adjust within safe limits.
• Common pitfalls: Missed doses, overlapping effects, improper storage, and misunderstanding of injection timing.
• Counselling strategies: Overcoming psychological insulin resistance and fostering long-term adherence through empathetic communication.
• Real-world relevance: Simplifying insulin use to support primary-care practitioners in resource-limited South African contexts.