the selection of initial pharmacotherapy is based on a detailed consideration of the clinical and biochemical characteristics of the patient. safety considerations must always be carefully considered since few, if any, antidiabetic agents are completely devoid of risk; some are appreciably more hazardous than others in certain clinical scenarios (see section 4). an assessment of the biochemical phenotype of the patient is required. however, in practice it can be difficult to judge whether insulin resistance or insulin deficiency is the dominant defect. as a rule, although it should be stressed, not invariably, younger patients at near-normal bodyweight are more likely to have greater insulin deficiency than