By rray, 9 February, 2023 Stepwise additional injections of prandial insulin i e 2 then 3 injections then proceed to full basal bolus regimen i e basal insulin and prandial insulin w each meal
By rray, 9 February, 2023 Titration Increase dose by 1 2 units or 10 to 15 twice weekly for hypoglycemia determine cause if no reason lower corresponding dose by 10 to 20
By rray, 9 February, 2023 Usually 1 dose w largest meal or meal w greatest PPG excursion prandial insulin can be dosed individually or mixed w NPH
By rray, 9 February, 2023 If A1C still above target add prandial insulin or if on bedtime NPH consider switch to bid NPH regimen4
By rray, 9 February, 2023 If above A1C target and not already on GLP 1 RA or GIP GLP 1 RA consider these classes either in free combo or fixed ratio combo w insulin
By rray, 9 February, 2023 Assess adequacy of basal insulin dose Consider clinical signals to evaluate for overbasalization and need to consider adjunctive tx e g basal dose 0 5 units kg day elevated bedtime morning and or postprandial differential hypoglycemia aware or unaware hig
By rray, 9 February, 2023 Titration Set FPG target choose evidence based titration algorithm e g increasing 2 units q3 days to reach FPG target w o hypoglycemia for hypoglycemia determine cause if no clear reason lower dose by 10 to 20