Insulin

Dr. McPhee gives you a disapproving look.

This is not the best choice for Mr. Green. While insulin is important in managing hyperglycaemia when first-line medications fail or in cases of severe, uncontrolled diabetes (e.g. HbA1c levels >10% or fasting blood glucose >300 mg/dL), it is not the most appropriate starting point for Mr. Green.

Starting insulin requires careful monitoring and increases the risk of hypoglycaemia and weight gain, which are significant concerns in Mr. Green, who is overweight and has hypertension. It is also administered subcutaneously and it is quite expensive. Try to think about other cost-effective agents with favourable weight and cardiovascular profiles.