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Initiation and titration of a basal insulin in type 2 diabetes

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Initiation and Titration of insulin:

The most common starting regimen in type 2 diabetes is a single injection, generally at night-time of a basal, long-acting insulin (e.g. insulin glargine, insulin detemir). If adequate control is not achieved using a basal insulin then consider introducing a twice-daily biphasic insulin or a basal-bolus regimen.

A suggested initiation regimen is outlined below (1):

1) Start insulin glargine ten units (usually evening)

2) Measure fasting blood glucose (FBG) in morning

3) Alter insulin dose according to chart below. Increases in glargine are make at weekly intervals - based on the previous weeks' reading

FBG (mmol/l) in morning	insulin dose change
<4	reduce insulin immediately to previous dose
4-6	make no change
6-8	increase dose by 2 units
8-10	increase dose by 4 units
>10	increase dose by 6 units

Reference:

Doctor (February 13th 2007):46-7.

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