INS and Hyperglycemia: Early initiation of insulin therapy is now advocated if hemoglobin A1C (HbA1C) remains above 7 % for 2 to 3 months despite dual oral therapy.(Nathan DM, Buse JB, Davidson MB, Ferrannini E, HolmanRR, Sherwin R, Zinman B. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes.