Final answer:
Initial management with insulin for type 2 diabetes is advised when fasting blood sugar levels are above 200 mg/dL. This level indicates severe hyperglycemia, which can require immediate insulin therapy. Other options listed do not provide justification for initiating insulin.
Step-by-step explanation:
When managing type 2 diabetes mellitus (DMT2), the use of insulin therapy as an initial treatment may be considered under certain conditions. According to the information provided, insulin therapy can be considered when the fasting blood sugar (FBS) level is significantly elevated. The appropriate scenario for starting insulin in previously undiagnosed DMT2 among the options given would be when the fasting blood sugar is above 200 mg/dL. This is because blood glucose levels should normally be lower than 100 mg/dL after fasting for at least 12 hours. A level above 125 mg/dL may indicate diabetes, and a level above 200 mg/dL is highly indicative of uncontrolled hyperglycemia and may justify the initiation of insulin therapy.
Option b, which indicates a random blood sugar below 100 mg/dL, is within the normal range and does not warrant starting insulin therapy. Option c, with a hemoglobin A1c of 5%, indicates a lack of diabetes as normal A1c levels are below 5.7%. Option d, citing that the patient is not hungry, is not a factor considered when deciding to initiate insulin therapy.
Therefore, initial management with insulin in previously undiagnosed DMT2 is warranted when the fasting blood sugar is above 200 mg/dL. This high level of glucose indicates that the patient may have severe hyperglycemia and potentially warrants prompt insulin therapy for glucose control.