The Role of Insulin Titration

Self-titration improves glycemic control

The American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) indicate that patients who have type 2 diabetes can improve their glycemic control with a dose plan for titrating insulin doses themselves according to self-monitored fasting blood glucose (FBG).1

AACE/ACE approach

When a patient’s A1C is less than 8%, the recommended total daily dose (TDD) of basal insulin should be 0.1 to 0.2 units/kg

When the A1C is greater than 8%, the recommended TDD of basal insulin should be 0.2 to 0.3 units/kg

Fixed regimen: Increase TDD by 2 units

Adjustable regimen:

  • FBG >180 mg/dL: add 20% of TDD

  • FBG = 140 to 180 mg/dL: add 10% of TDD

  • FBG = 110 to 139 mg/dL: add 1 unit

If hypoglycemia is evident, reduce the TDD by the following:

  • Blood glucose <70 mg/dL: 10% to 20%

  • Blood glucose <40 mg/dL: 20% to 40%

Consider discontinuing or reducing sulfonylurea after starting basal insulin (basal analogs preferred to neutral protamine Hagedorn).

My Dose Coach™ can help!

My Dose Coach uses your individualized dose instructions to help adult patients who have type 2 diabetes with long-acting basal insulin titration based on each patient’s FBG level and history of hypoglycemia. It’s a way to initiate and update basal insulin dosing according to your custom titration instructions via an HCP Web portal and a patient’s smartphone.

Reference

1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm. Endocr Pract. 2016;22:84-113.