Insulin Dose Adjustment for Hyperglycemia

Initial Dose Adjustment

For patients with persistent hyperglycemia on basal insulin, an immediate dose increase of 20% is recommended to address significant hyperglycemia, according to the American Diabetes Association 1, 2
After the initial adjustment, implement a structured titration algorithm: increase by 2 units every 3 days until reaching target fasting plasma glucose without hypoglycemia, as recommended by the American Diabetes Association 1, 3
Set a fasting glucose target of 90-150 mg/dL to achieve optimal glycemic control, as suggested by the American Diabetes Association 1, 4

Monitor fasting finger-stick glucose values over a week to guide further dose adjustments, according to the American Diabetes Association 4
If 50% of fasting glucose values remain above target, continue increasing by 2 units, as recommended by the American Diabetes Association 1, 4
If any fasting glucose readings fall below 80 mg/dL more than twice in a week, decrease the dose by 2 units, according to the American Diabetes Association 2, 4

If blood sugars remain elevated after basal insulin optimization, consider adding prandial insulin or non-insulin agents, as suggested by the American Diabetes Association 1, 5
For significant postprandial hyperglycemia, consider adding prandial insulin starting with one dose at the largest meal, according to the American Diabetes Association 1, 2

Always check for hypoglycemic episodes before increasing insulin dose, as recommended by the American Diabetes Association 1, 2
Consider patient's renal function, as impaired kidney function increases hypoglycemia risk and may require more cautious titration, according to the Mayo Clinic 6
Ensure patient is properly educated on injection technique, timing, and storage of insulin to maximize effectiveness, as suggested by the American Diabetes Association 7