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Dr Spellman is an associate professor of medicine in the Division of Endocrinology and director of the Diabetes Center at the University of North Texas Health Science Center at Fort Worth.

Correspondence to Craig W. Spellman, PhD, DO, Department of Internal Medicine, Division of Endocrinology, University of North Texas Health Science Center at Fort Worth, PCC-3, 855 Montgomery St, Fort Worth, TX 76107-2699E-mail: cspellma{at}hsc.unt.edu

This clinical review looks at tight control of blood glucose with oral agents and insulin in adults and children with type 2 diabetes mellitus. It includes recommendations based on the treatment algorithms from the Texas Diabetes Council. The focus is on specific indications for selecting initial monotherapy, early dual therapy, or combination oral therapy. Discussion includes glycemic targets and times to goal along with recommendations for insulin management that depend on patient stratification as "treatment naïve" or "combination oral agent failures" (defined as A1c value 9.5% or >9.5%). This presentation also includes protocols for once-daily injections, multidose insulin injections, and intensive insulin therapy (physiologic insulin delivery) as well as discussion of starting doses, titration schedules, optimum basal bolus insulin regimen, and calculation of insulin augmentation.