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If it is less than 130 mg/dL and the pre-dinner blood glucose level is still not at the target, adding a third injection of pre-mixed insulin before lunch should be considered, starting with 6 units and titrating weekly based on pre-dinner blood glucose levels [47]

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Compounded Tirzepatide is marketed as the most effective option

[PubMed: 23644179] 136

Estimates suggest there are about 4 million people in the UK living with atherosclerotic cardiovascular disease, who remain at very high risk of subsequent or further heart attacks and strokes, and related deaths despite our best available treatments

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