What are the prescription templates for managing and treating type 2 diabetes mellitus, including all possible case scenarios?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 25, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Type 2 Diabetes Mellitus Prescription Templates

Template 1: Newly Diagnosed, Metabolically Stable (A1C <8.5%, No Ketosis)

Start metformin 500 mg PO daily with dinner immediately at diagnosis alongside lifestyle modifications. 1, 2

Prescription:

  • Metformin 500 mg tablets
  • Sig: Take 1 tablet by mouth daily with dinner
  • Disp: 30 tablets
  • Refills: 3
  • Titration: Increase by 500 mg every 1-2 weeks as tolerated to target dose of 2000 mg daily in divided doses (1000 mg twice daily with meals) 2

Lifestyle prescription:

  • 60 minutes moderate-to-vigorous physical activity daily (for youth) 1 or 150 minutes/week spread over at least 3 days (for adults) 1
  • Limit screen time to <2 hours daily 1
  • Restrict calorie intake to 1500 kcal/day 1
  • Fat intake 30-35% of total energy, with <10% saturated fat 1
  • Eliminate sugar-sweetened beverages 1

Monitoring:

  • A1C every 3 months until target <7% achieved 1, 2
  • Finger-stick glucose monitoring only if not meeting targets or changing regimen 1

Template 2: Newly Diagnosed with Severe Hyperglycemia (A1C ≥8.5% or Glucose ≥250 mg/dL, No Ketoacidosis)

Initiate dual therapy with insulin plus metformin from the outset for patients with marked hyperglycemia. 1, 2

Prescription 1:

  • Insulin glargine (Lantus) 100 units/mL vial or pen
  • Sig: Inject 0.5 units/kg subcutaneously once daily at bedtime
  • Disp: 1 vial (10 mL) or 5 pens
  • Refills: 3
  • Starting dose calculation: For 80 kg patient = 40 units daily 1

Prescription 2:

  • Metformin 500 mg tablets
  • Sig: Take 1 tablet by mouth daily with dinner
  • Disp: 30 tablets
  • Refills: 3
  • Titrate to 2000 mg daily as tolerated 1, 2

Prescription 3:

  • Lancets and glucose test strips
  • Sig: Check fasting and bedtime blood glucose daily
  • Disp: 100 strips and 100 lancets
  • Refills: 3

Monitoring:

  • Daily finger-stick glucose (fasting and bedtime) 1
  • A1C every 3 months 1
  • Adjust insulin dose by 10-15% every 3-7 days based on fasting glucose targets

Template 3: Diabetic Ketoacidosis or Marked Ketosis

Admit for IV insulin infusion per DKA protocol until acidosis resolves, then transition to subcutaneous insulin. 1

Inpatient Protocol:

  • IV insulin infusion 0.1 units/kg/hour until anion gap closes and pH >7.3 1
  • Transition to subcutaneous insulin when acidosis resolves

Discharge Prescription 1:

  • Insulin glargine 100 units/mL
  • Sig: Inject 0.5 units/kg subcutaneously once daily at bedtime
  • Disp: 1 vial or 5 pens
  • Refills: 3

Discharge Prescription 2:

  • Insulin lispro (Humalog) or aspart (Novolog) 100 units/mL
  • Sig: Inject with meals based on carbohydrate counting (starting 1 unit per 15g carbohydrate)
  • Disp: 1 vial or 5 pens
  • Refills: 3

Discharge Prescription 3:

  • Metformin 500 mg tablets
  • Sig: Take 1 tablet by mouth daily with dinner (start after ketosis fully resolved)
  • Disp: 30 tablets
  • Refills: 3

Template 4: Patient with Established Cardiovascular Disease or Heart Failure

Add cardioprotective agents (SGLT2i or GLP-1 RA) to metformin regardless of A1C for cardiovascular risk reduction. 2, 3

Prescription 1:

  • Metformin 1000 mg tablets
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Prescription 2 (Option A - SGLT2i):

  • Empagliflozin (Jardiance) 10 mg tablets
  • Sig: Take 1 tablet by mouth once daily in the morning
  • Disp: 30 tablets
  • Refills: 3
  • Note: Reduces cardiovascular death by 12-26% and heart failure by 18-25% 3

Prescription 2 (Option B - GLP-1 RA):

  • Semaglutide (Ozempic) 0.25 mg/0.5 mg pen
  • Sig: Inject 0.25 mg subcutaneously once weekly for 4 weeks, then increase to 0.5 mg weekly
  • Disp: 1 pen (4 doses)
  • Refills: 3
  • Titrate to 1.0 mg weekly if needed for glycemic control 2

Monitoring:

  • A1C every 3 months 1
  • Monitor for genital mycotic infections (4% incidence with SGLT2i) 4
  • Monitor for urinary tract infections (increased with SGLT2i) 4

Template 5: Patient with Chronic Kidney Disease (eGFR 30-60 mL/min/1.73 m²)

Use metformin if eGFR >30 plus SGLT2i for renal protection (24-39% risk reduction for kidney disease progression). 2, 3

Prescription 1:

  • Metformin 500 mg tablets (safe if eGFR >30) 2
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3
  • Maximum dose 1000 mg daily if eGFR 30-45 mL/min/1.73 m²

Prescription 2:

  • Empagliflozin (Jardiance) 10 mg tablets
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3
  • Note: Approved for use down to eGFR 20 mL/min/1.73 m² 2

Alternative:

  • Canagliflozin (Invokana) 100 mg tablets
  • Sig: Take 1 tablet by mouth once daily before first meal
  • Disp: 30 tablets
  • Refills: 3

Monitoring:

  • Serum creatinine and eGFR at baseline, week 12, and week 24 4
  • Expect acute 0.1 mg/dL creatinine increase and 2-4 mL/min eGFR decrease (reversible) 4
  • A1C every 3 months 1

Template 6: Pediatric/Adolescent Patient (Ages 10-18)

Initiate metformin with intensive family-centered lifestyle intervention at diagnosis. 1, 2

Prescription:

  • Metformin 500 mg tablets
  • Sig: Take 1 tablet by mouth once daily with dinner
  • Disp: 30 tablets
  • Refills: 3
  • Titrate by 500 mg weekly to maximum 2000 mg daily in divided doses 1

Family lifestyle prescription:

  • 60 minutes moderate-to-vigorous physical activity daily 1
  • Muscle and bone strengthening exercises 3 days/week 1
  • Screen time <2 hours daily 1
  • Target 7-10% decrease in excess weight 1
  • Eliminate sugar-sweetened beverages 1

For A1C ≥8.5% in youth:

  • Add insulin glargine 0.5 units/kg subcutaneously at bedtime 1
  • Continue metformin titration 1

Monitoring:

  • A1C every 3 months 1
  • Target A1C <7% (can aim for <6.5% if achievable without hypoglycemia) 1

Template 7: Inadequate Control on Metformin Monotherapy (A1C >7% After 3-6 Months)

Add a second agent from a different class; prioritize SGLT2i or GLP-1 RA for cardiovascular/renal benefits. 1, 2, 5

Existing Prescription:

  • Metformin 1000 mg twice daily (continue)

Add Prescription (Option A - SGLT2i):

  • Empagliflozin (Jardiance) 10 mg tablets
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3
  • Expected A1C reduction: 0.5-1.0% 1

Add Prescription (Option B - GLP-1 RA):

  • Dulaglutide (Trulicity) 0.75 mg pen
  • Sig: Inject 0.75 mg subcutaneously once weekly
  • Disp: 4 pens
  • Refills: 3
  • Increase to 1.5 mg weekly after 4 weeks if tolerated
  • Expected A1C reduction: 1.0-1.5% 1

Add Prescription (Option C - DPP-4 inhibitor if SGLT2i/GLP-1 RA contraindicated):

  • Sitagliptin (Januvia) 100 mg tablets
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3
  • Expected A1C reduction: 0.5-1.0% 1

Template 8: Triple Combination Therapy (Inadequate Control on Dual Therapy)

Combine metformin + SGLT2i + GLP-1 RA for maximum cardiovascular and metabolic benefit. 5

Prescription 1:

  • Metformin 1000 mg tablets
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Prescription 2:

  • Empagliflozin (Jardiance) 25 mg tablets (increase from 10 mg if tolerated)
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3

Prescription 3:

  • Semaglutide (Ozempic) 1.0 mg pen
  • Sig: Inject 1.0 mg subcutaneously once weekly
  • Disp: 4 pens
  • Refills: 3

Note: This combination provides superior reduction in 3-point MACE, total mortality, and heart failure compared to other combinations based on real-world evidence 5

Monitoring:

  • A1C every 3 months 1
  • Weight and blood pressure at each visit
  • Monitor for GI side effects from GLP-1 RA (nausea, vomiting)

Template 9: Patient Requiring Insulin (Triple Oral Therapy Insufficient)

Add basal insulin to existing oral agents; approximately 25% of type 2 diabetes patients require insulin. 5

Continue existing oral medications:

  • Metformin 1000 mg twice daily
  • Empagliflozin 25 mg daily
  • Continue or discontinue GLP-1 RA based on cost/tolerance

Add Prescription:

  • Insulin glargine (Lantus) U-100 or insulin degludec (Tresiba) U-100
  • Sig: Inject 10 units (or 0.1-0.2 units/kg) subcutaneously once daily at bedtime
  • Disp: 1 vial or 5 pens
  • Refills: 3
  • Titrate by 2 units every 3 days until fasting glucose 80-130 mg/dL 1

Prescription for monitoring:

  • Blood glucose test strips and lancets
  • Sig: Check fasting blood glucose daily
  • Disp: 100 strips and lancets
  • Refills: 3

If basal insulin insufficient, add mealtime insulin:

  • Insulin lispro, aspart, or glulisine
  • Sig: Inject 4 units (or 10% of basal dose) before each meal
  • Disp: 1 vial or 5 pens
  • Refills: 3

Template 10: Patient on Insulin + Sulfonylurea (High Hypoglycemia Risk)

Discontinue sulfonylurea and optimize insulin dosing to reduce hypoglycemia risk. 5

Discontinue:

  • Glimepiride or glyburide (associated with higher mortality) 5

Prescription 1:

  • Insulin glargine U-100
  • Sig: Inject current total daily dose subcutaneously once daily at bedtime
  • Disp: 1 vial or 5 pens
  • Refills: 3
  • Reduce dose by 20% when stopping sulfonylurea to prevent hypoglycemia

Prescription 2:

  • Metformin 1000 mg tablets
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Add cardioprotective agent:

  • Empagliflozin 10 mg daily or GLP-1 RA as per Templates 4 or 7

Monitoring:

  • Finger-stick glucose before meals and bedtime for 2 weeks after sulfonylurea discontinuation 1
  • A1C every 3 months 1

Template 11: Patient with Obesity (BMI >30) Requiring Weight Loss

Prioritize high-potency GLP-1 RA or dual GIP/GLP-1 RA for >10% weight loss. 3

Prescription 1:

  • Semaglutide (Ozempic) 0.25 mg/0.5 mg pen
  • Sig: Inject 0.25 mg subcutaneously once weekly for 4 weeks, then 0.5 mg weekly for 4 weeks, then 1.0 mg weekly
  • Disp: 1 pen
  • Refills: 3
  • Can increase to 2.0 mg weekly if needed 3

Alternative (Dual GIP/GLP-1 RA):

  • Tirzepatide (Mounjaro) 2.5 mg pen
  • Sig: Inject 2.5 mg subcutaneously once weekly for 4 weeks, then increase by 2.5 mg every 4 weeks
  • Disp: 4 pens
  • Refills: 3
  • Titrate to 5 mg, 7.5 mg, 10 mg, or 15 mg weekly as tolerated
  • Expected weight loss >10% 3

Prescription 2:

  • Metformin 1000 mg tablets
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Lifestyle prescription:

  • 1500 kcal/day diet 1
  • 150 minutes/week moderate-intensity exercise 1
  • Target 7-10% weight reduction 1

Template 12: Patient on Pioglitazone Combination (Less Common, Specific Indication)

Use when insulin resistance is predominant and other agents contraindicated. 4

Prescription 1:

  • Pioglitazone 30 mg tablets
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3

Prescription 2:

  • Metformin 1000 mg tablets
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Prescription 3:

  • Empagliflozin 10 mg tablets
  • Sig: Take 1 tablet by mouth once daily
  • Disp: 30 tablets
  • Refills: 3
  • Expected A1C reduction with this combination: 0.6-0.7% 4

Monitoring:

  • Monitor for weight gain (pioglitazone causes 0.6% increase vs 2% decrease with SGLT2i) 4
  • Monitor for edema and heart failure symptoms
  • A1C every 3 months 1

Template 13: Intensive Insulin Regimen (Multiple Daily Injections)

For patients with significant insulin deficiency or A1C >9% despite oral agents. 4, 5

Prescription 1 (Basal insulin):

  • Insulin glargine U-100 or degludec U-100
  • Sig: Inject 0.3-0.5 units/kg subcutaneously once daily at bedtime
  • Disp: 1 vial or 5 pens
  • Refills: 3

Prescription 2 (Bolus insulin):

  • Insulin lispro, aspart, or glulisine U-100
  • Sig: Inject before each meal using carbohydrate ratio (start 1:15 ratio) and correction factor
  • Disp: 1 vial or 5 pens
  • Refills: 3

Prescription 3:

  • Metformin 1000 mg tablets (continue if eGFR permits)
  • Sig: Take 1 tablet by mouth twice daily with meals
  • Disp: 60 tablets
  • Refills: 3

Prescription 4:

  • Blood glucose test strips and lancets
  • Sig: Check before each meal and at bedtime (4 times daily)
  • Disp: 150 strips and lancets monthly
  • Refills: 3

Expected hypoglycemia rate: 28-41% overall hypoglycemia, <1% severe hypoglycemia 4

Key Monitoring Parameters Across All Templates

  • A1C: Every 3 months until target achieved, then every 6 months 1, 2
  • Finger-stick glucose: Only when on insulin, sulfonylureas, changing regimen, or not meeting targets 1
  • Renal function: Baseline and periodically, especially with metformin (contraindicated if eGFR <30) and SGLT2i 4
  • Lipid panel: Monitor LDL-C with SGLT2i (increases 2-6%) 4
  • Hematocrit: Increases 2.8% with SGLT2i 4
  • Blood pressure: At each visit (target <140/90 mmHg, <130/80 if high CV risk) 1

Common Pitfalls to Avoid

  • Do not delay insulin in patients with A1C ≥8.5% or glucose ≥250 mg/dL 1
  • Do not use sulfonylureas as preferred second-line agents due to higher mortality and hypoglycemia risk 5
  • Do not withhold SGLT2i/GLP-1 RA in patients with cardiovascular disease regardless of A1C 2, 3
  • Do not continue metformin if eGFR <30 mL/min/1.73 m² 2
  • Do not ignore lifestyle intervention—it reduces A1C by 2% and is as effective as any single drug 1
  • Do not use acarbose or older agents when modern cardioprotective options are available 1

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Type 2 Diabetes Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

What are the prescription templates for managing and treating type 2 diabetes mellitus, including all possible case scenarios?
What are the prescription templates for type 2 diabetes mellitus (T2DM) management and treatment, including all case scenarios?
What are the initial treatment guidelines for type 2 diabetes mellitus (DM)?
What is the treatment for type 2 diabetes?
What are the initial management and criteria for choosing pharmacotherapy in a newly diagnosed patient with type 2 diabetes mellitus (T2DM)?
What is the lymphatic drainage pattern of each level of lymph node?
What is the recommended treatment for perforated appendicitis?
What is the workup for rheumatoid arthritis (RA)?
Which head and neck lesions drain into which levels of lymph nodes?
What are recommended multivitamin brands for a 2-year-old, such as Flintstones (multivitamin with vitamins and minerals) or Gerber (multivitamin with vitamins and minerals)?
What is the best approach to prevent postpartum pelvic infection in a patient at 37 weeks gestation with premature rupture of membranes (PROM) for 24 hours?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question