[i]1. we check sugar levels only a periodic intervals, are there possibilities that the sugar could go high during the tablets being taken between morning and night dose, how do we know or what are the symptoms and can this small surge cause damage to any internal part ?[/i] Yes. There is a possibility that sugars might shoot up or go low anytime during 24 hours. Its a good practice to moniter blood glucose levels at home at different times (Fasting, prelunch, post lunch, pre dinner, post dinner). Your sugars seem alright as of now. You can monitor 2 values in a week by glucometer. Additionally, you can do a test called Hba1c every 3 or 4 months, which refelects your sugar control over past 2-3 months. ------------------------------------------------------------------------------------------------------------------------------------- [i]2. Is it advisable to start insulin directly instead of tablets, if yes, what would be its side effect? [/i] Type 2 diabetes, initially, has insulin resistance. So insulin levels in blood are actually high. It s just that the insulin is not utilized properly. Oral drugs make sure that body insulin is used properly. So there is no added advantage of starting insulin very early in type 2 diabetes.