Toujeo Dose Adjustment Guidelines

Standard Titration Algorithm

The American Diabetes Association recommends increasing Toujeo by 2 units every 3 days if fasting glucose is 140-179 mg/dL, or by 4 units every 3 days if fasting glucose is ≥180 mg/dL, until reaching a target fasting plasma glucose of 80-130 mg/dL 1, 2
For patients with fasting glucose 140-179 mg/dL, the American Diabetes Association suggests increasing Toujeo by 2 units every 3 days 1, 2
For patients with fasting glucose ≥180 mg/dL, the American Diabetes Association recommends increasing Toujeo by 4 units every 3 days 1, 2
The target fasting glucose is 80-130 mg/dL, as recommended by the American Diabetes Association 1, 2
For hypoglycemia without clear cause, the American Diabetes Association recommends reducing the dose by 10-20% immediately 1, 2

The American Diabetes Association recommends stopping the increase of Toujeo when the dose exceeds 0.5 units/kg/day and instead adding prandial insulin or a GLP-1 receptor agonist 1, 2
Clinical signals that indicate reaching this threshold include basal insulin dose >0.5 units/kg/day, bedtime-to-morning glucose differential ≥50 mg/dL, hypoglycemia episodes, and high glucose variability 2

The American Diabetes Association recommends daily fasting blood glucose monitoring during active titration 1, 2
It is essential to reassess the adequacy of insulin dose at every clinical visit, as recommended by the American Diabetes Association 1
The American Diabetes Association suggests looking for signs of overbasalization at each assessment 2
If more than 2 fasting glucose values per week are <80 mg/dL, the American Diabetes Association recommends decreasing the dose by 2 units 2, 3

The American Diabetes Association recommends never delaying dose adjustments, and adjusting every 3 days in stable patients 2
It is crucial to recognize when basal insulin alone is insufficient, and add prandial insulin or a GLP-1 receptor agonist rather than continuing to escalate Toujeo, as recommended by the American Diabetes Association 1, 2
The American Diabetes Association suggests continuing metformin unless contraindicated when intensifying insulin therapy 2, 4