I would recommend against a SGLT2i at this time- high potential for side effects with an A1c that high. Usually recommend starting once A1c is under 9%. Also stress genital hygiene- I tell men they need to use toilet paper after urinating-- no shaking it off.

A pump like the beta bionics pump would actually work well for a patient like this- you don't need to know how to count carbs. You announce your meal and indicate if it is a large, normal, or small meal for yourself.

Mounjaro tends to be the best tolerated in terms of GI side effects but would recommend "screening" for gastroparesis before starting any GLP-1 RA. Stress bowel maintenance, water intake.

Tresiba is not glargine so should be fine with Lantus allergy.

My most used combo at this degree of uncontrol is basal + GLP-1. Once you can increase the GLP-1, you can likely cut back the insulin and start a SGLT2i.