The decision to start insulin therapy is straightforward in patients with very poor glycaemic control, for example, blood glucose exceeding 300 mg/dl (16.7 mmol/L) or HbA1c >11% (97 mmol/mol) and in those with symptomatic hyperglycaemia or with evidence of catabolic state as reflected by weight loss or ketosis.2, 8. Here, INS is linked to Hyperglycemia.