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Importantly, fertility is a long-term consideration spermatogenesis takes ~74 days, so any intervention or insult could take 23 months to manifest in semen changes

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Given the very high HbA1c you decide it is safe not to reduce the glipizide or insulin doses at this stage, but ask Mr V to monitor for hypoglycaemic symptoms and to measure his blood glucose before breakfast and before dinner for 3 days before he next sees you

These types of studies establish confidence in the outcomes, as neither the scientists nor the participants are aware of who receives actual medication versus a placebo during the trial

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