Due to the progressive nature of T2DM, insulin therapy is eventually indicated for many patients with T2DM [5]. The progressive nature of T2DM and its therapies should regularly be explained in a matter-of-fact manner to patients, avoiding using insulin as a threat or describing it as a failure or punishment [6]. If a patient presents with significant hyperglycemic symptoms and/or has dramatically elevated plasma glucose concentrations insulin therapy should be strongly considered from the outset [7]. But in most patients insulin is prescribed after combination therapy with metformin and an additional 1–2 oral or injectable agents