INS and diabetes mellitus: Insulin should always be used in hyperglycaemic emergencies.28 Based on the expected HbA1c reduction of other antihyperglycaemic agents and the general target of ~7%, current guidelines endorse the initiation of insulin when HbA1c > 10% even at diabetes diagnosis, as the use of oral agents alone is unlikely to achieve targets.28 The early introduction of insulin should also be considered if: