In this fourth episode, Dr Tebelele and Dr Mashitisho move from insulin theory to the practical initiation and management of insulin therapy in patients with Type 2 Diabetes Mellitus (T2DM). The discussion walks through the clinical steps required to start insulin confidently, covering dose calculation, titration, patient instruction, and ongoing follow-up.

Recognising that many primary-care practitioners hesitate to prescribe insulin, this session provides reassurance, clarity, and practical guidance on how to overcome those barriers. It focuses on real-world application in South Africa’s resource-diverse settings—where limited time, patient fear, and follow-up challenges demand efficient, patient-centred strategies.

1. Identify appropriate candidates for insulin initiation based on glycaemic control and clinical status.
2. Select the correct starting insulin (basal, premixed, or basal bolus) according to patient profile and context.
3. Demonstrate the practical steps of initiating insulin—including dose calculation, injection technique, and patient education.
4. Apply structured titration algorithms and monitoring schedules to maintain safe, effective glycaemic control.
5. Address patient fears, myths, and adherence challenges through empathetic communication.

• Initiate insulin therapy safely and confidently in patients with Type 2 Diabetes.
• Select appropriate insulin regimens tailored to patient needs and resources.
• Educate patients effectively about self-monitoring, injection technique, and hypoglycaemia prevention.
• Implement simple titration protocols in routine clinical practice.
• Build long-term relationships that support adherence and empowerment in diabetes care.

• Overcoming fear: Many clinicians hesitate to initiate insulin; education and support are key to confidence.
• When to start insulin: Persistent hyperglycaemia despite maximal oral therapy, weight loss, catabolic symptoms, or acute illness.
• Initial dosing: Starting low (e.g. 10 units once daily) and titrating gradually based on fasting glucose and patient response.
• Technique matters: Correct injection sites, rotation, needle handling, and timing relative to meals.
• Patient empowerment: Demonstrating injection in-practice, encouraging self-monitoring, and addressing misconceptions (“insulin means failure”).
• Follow-up and titration: Regular review, use of glucose logs, and collaborative adjustment of doses.
• Holistic approach: Combining insulin with lifestyle support, oral agents, and education to achieve sustainable control.