Type 2 Diabetes and Insulin
Steps in Insulin Management
Step 1: Target FPG with basal insulin
- Goal for FPG is 70 to 130 mg/dL.*
- Start with a bedtime dose of basal insulin 10 units (or 0.2 units/kg body weight). Increase the dose by 2 units every 3 days until FPG is 70 to 130 mg/dL.*
- The dose maybe increased by 4 units every 3 days if FPG is >180 mg/dL.*
Step 2: Target premeal glucose, one target at a time.
- Target goal for premeal glucose is between 70 – 130 mg/dL.*
- If pre-lunch glucose is >130 mg/dL*, start 4 units of Bolus insulin before breakfast.
- If pre-supper glucose is >130 mg/L*, start 4 units of Bolus insulin before lunch OR add or increase morning NPH/levemir.
- If bedtime glucose is above target (e.g. >140 mg/dL*), start 4 units of Bolus insulin before supper OR Increase evening NPH/levemir.
- Increase Bolus insulin by 2 units every 3 days.
- As insulin doses get larger (over 10 units), begin to change insulin dose by 10 to 20%.
Step 3: Target postprandial glucose
- If A1C is not at goal, target the post-prandial glucose with Bolus premeal insulin. The 2 hour post-prandial glucose target is <160 mg/dL to 180 mg/dL.*
*Note: Glucose targets should be individualized based on patient comorbidities, needs and response to blood glucose lowering
Nathan, DM. et. al. Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy.
Diabetes Care 2009; 32:193–203.
Podcast on insulin management available by Richard M Bergenstal, MD.