Summary of Guidelines for Initiation and Titration of Basal Insulin in Patients With Type 2 Diabetes8,39,56,71
| Body | A1C Target | Initiate with | Initial Dose of Basal Insulin | Titrate to* | Titration Instructions | Considerations |
|---|---|---|---|---|---|---|
| American Diabetes Association/ European Association for the Study of Diabetes | 7.0% | Basal insulin | 10 U or 0.1 to 0.2 U/kg per day | FPG <130 mg/dL | 2 to 4 U once or twice weekly | Target A1C (to be individualized): <7.0% |
| Consider individual patient factors when setting A1C target (health status, concomitant illness, etc.) | ||||||
| An algorithm for self titration of insulin doses improves glycemic control | ||||||
| International Diabetes Federation | <7.0% | Basal or premix insulin | — | FPG <115 mg/dL | Dose increases of 2 U every 3 days | Explain at diagnosis that because of disease progression, insulin eventually may be the best option for glycemic control |
| Do not unduly delay the commencement of insulin | ||||||
| Initiate insulin using a self-titration regimen | ||||||
| Explain that starting doses of insulin are low, for safety reasons, but that eventual dose requirement is expected to be 30 to 100 U/day | ||||||
| American Association of Clinical Endocrinologists/American College of Endocrinology | ≤6.5% | Basal insulin | If A1C <8.0%: 0.1–0.2 U/kg | FPG <110 mg/dL | Dose increases of 2 U every 3 days | Target A1C for patients without serious concurrent illness and low hypoglycemia risk: ≤6.5% |
| If A1C >8.0%: 0.2–0.3 U/kg | A1C target must be individualized | |||||
| Minimizing risk of hypoglycemia is a priority | ||||||
| Minimizing risk of weight gain is a priority |
↵* Generally a range from ≥80 mg/dL to upper limit shown here.
A1C, glycated hemoglobin A1C; FPG, fasting plasma glucose.