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<sup>1</sup> When selecting GLP-1 RA, consider pt preference, A1C lowering, wt-lowering effect, or freq of injection. If CVD: Consider GLP-1 RA w/ proven CVD benefit. PO or injectable GLP-1 RA is appropriate.<br><br>
<sup>2</sup> For pts on GLP-1 RA and basal insulin combo, consider fixed-ratio combo product (IDegLira or iGlarLixi).<br><br>
<sup>3</sup> Consider switch from evening NPH to basal analog if pt develops hypoglycemia and/or frequently forgets to administer NPH in the evening and would be better managed w/ morning dose of long-acting basal insulin. <br><br>
<sup>4</sup> <b>Conversion of bedtime NPH to bid NPH</b> based on individual needs and current glycemic control. One possible approach:<br>
• <b>Initiation:</b> Total dose = 80% of current NPH dose; 2/3 given in AM, 1/3 in PM.<br>
• <b>Titration:</b> based on individual needs.<br>
• If still above target A1C, proceed to prandial insulin.<br><br>
<sup>5</sup> <b>Self-mixed/split insulin regimen:</b><br>
• <b>Initiation:</b> Total NPH dose = 80% of current NPH dose; 2/3 given before breakfast, 1/3 given before dinner; add 4 units of short/rapid-acting insulin to each injection or 10% of reduced NPH dose.<br>
• <b>Titration:</b> Titrate each component of regimen based on individual needs.<br><br>
<sup>6</sup> <b>Twice-daily premix insulin regimen:</b><br>
• <b>Initiation:</b> usually unit per unit at same total insulin dose but may require adjustment to individual needs.<br>
• <b>Titration:</b> based on individual needs.
<sup>2</sup> For pts on GLP-1 RA and basal insulin combo, consider fixed-ratio combo product (IDegLira or iGlarLixi).<br><br>
<sup>3</sup> Consider switch from evening NPH to basal analog if pt develops hypoglycemia and/or frequently forgets to administer NPH in the evening and would be better managed w/ morning dose of long-acting basal insulin. <br><br>
<sup>4</sup> <b>Conversion of bedtime NPH to bid NPH</b> based on individual needs and current glycemic control. One possible approach:<br>
• <b>Initiation:</b> Total dose = 80% of current NPH dose; 2/3 given in AM, 1/3 in PM.<br>
• <b>Titration:</b> based on individual needs.<br>
• If still above target A1C, proceed to prandial insulin.<br><br>
<sup>5</sup> <b>Self-mixed/split insulin regimen:</b><br>
• <b>Initiation:</b> Total NPH dose = 80% of current NPH dose; 2/3 given before breakfast, 1/3 given before dinner; add 4 units of short/rapid-acting insulin to each injection or 10% of reduced NPH dose.<br>
• <b>Titration:</b> Titrate each component of regimen based on individual needs.<br><br>
<sup>6</sup> <b>Twice-daily premix insulin regimen:</b><br>
• <b>Initiation:</b> usually unit per unit at same total insulin dose but may require adjustment to individual needs.<br>
• <b>Titration:</b> based on individual needs.
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To meet individual tx goals, use principles from above sections, including reinforcement of behavioral interventions (wt mgmt, physical activity) and provision of DM self-mgmt education and support (DSMES).