1. Initiate insulin- 
-start with weight based basal dose of lantus, or start with 10 units.
-0.2units/kg
-If Cr clearance <60, divide insulin by half since its renally cleared.
-Titrate until their fasting sugars are at goal (typically fasting 80 to 120-125, 2 hour post prandial 150-180)
-If fasting sugars are good but A1C is high, consider adding mealtime coverage
-Once you're at over 50 Units, divide into 2 doses for better absorption.
2. A1C goals
-Based on ACCORD trial : randomized older, sicker people to either go to A1C of 6.5 or 7.5; mortality was higher in more aggressively managed group 2/2 more hypoglycemic episodes.
-6.5 - if young, not a lot of comorbidities, and not having hypoglycemic episodes
-7 - most people. Evidence shows it reduces microvascular complications of DM, and will reduce microvascular disease if reached soon after diagnosis.
-7-8 - old, lots of comorbidities, history of severe hypoglycemia, risk of falls, longstanding DM, bad micro/macrovascular disease.
3. Glucose monitoring - home glucose monitoring has not been shown to improve sugar control.
4. Hypoglycemia
-Take 15-20 g glucose dose
-Wait 15 mins, then given another dose
-Have a snack/meal once you're back to normal.
-If its really bad, can have glucagon at home to give for rescue
5. Retinopathy
-Most frequent cause of new blindness between 20-75 years of age.
-Sx: blurry, spots, floaters.
6. Neuropathy
-stocking glove
-risk factors: dm duration/control, htn, cholesterol
-exam: monofilament (6 sites on each foot; loss of any 1 indicates neuropathy)
-tx: gabapentin, TCAs (ami/nor), lyrica, duloxetine, NSAIDs do not work.
7. Charcot joint
-microtrauma leading to joint destruction, fracture, dislocation
-15% of diabetics.
-sx: swelling, stiffness, instablility
-tx with braces, joint replacement
8. Nephropathy 
-Microalbuminuria -> Cr rise.
-Screen: annual albumin/cr ratio.
9. CV goals:
-BP <140/90
-Statins for everyone; high (atorv 40-80, rosu 20-40) if high risk CVD, or mod-low dose if mod-low risk.
-Aspirin if CV risk > 10% (generally all diabetic men > 50, women >60 who have 1 more major risk factor- (fam history early CAD, htn, smoking, microalbuinuria, dyslipidemia)
10. Prevention
-Pneumovax once before 65 and again after 65
-Hep B vaccination 20-60