Table 1.

Summary of Guidelines for Initiation and Titration of Basal Insulin in Patients With Type 2 Diabetes8,39,56,71

BodyA1C TargetInitiate withInitial Dose of Basal InsulinTitrate to*Titration InstructionsConsiderations
American Diabetes Association/ European Association for the Study of Diabetes7.0%Basal insulin10 U or 0.1 to 0.2 U/kg per dayFPG <130 mg/dL2 to 4 U once or twice weeklyTarget 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 insulinFPG <115 mg/dLDose increases of 2 U every 3 daysExplain 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 insulinIf A1C <8.0%: 0.1–0.2 U/kgFPG <110 mg/dLDose increases of 2 U every 3 daysTarget A1C for patients without serious concurrent illness and low hypoglycemia risk: ≤6.5%
If A1C >8.0%: 0.2–0.3 U/kgA1C 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.