Insulin Aspart Dose Adjustment for Poorly Controlled Type 2 Diabetes

Assessment of Current Glycemic Control

• The patient has severely uncontrolled type 2 diabetes with an A1c >12% and persistent hyperglycemia despite the recent transition to a basal-bolus regimen 2
• Blood glucose readings show continued hyperglycemia with multiple readings above high blood glucose levels 1, 3
• The patient is currently on a basal-bolus regimen with Glargine and Aspart insulins 1, 2

Rationale for Increasing Mealtime Insulin

• When basal insulin has been titrated but A1c remains above target, adjustments to mealtime insulin are necessary to address postprandial glucose excursions 2, 4
• The patient's blood glucose readings show persistent postprandial hyperglycemia despite the addition of mealtime insulin 1, 3
• The American Diabetes Association guidelines recommend dose titration of both basal and mealtime insulins based on prevailing blood glucose levels to achieve glycemic targets 5, 6

Recommended Approach

• Increase insulin aspart dose by 2-3 units per meal based on the persistent hyperglycemia shown in blood glucose readings 1, 2
• Titrate the insulin aspart dose using a simple algorithm, increasing by 1-2 units once or twice weekly if postprandial glucose remains above target 3, 7

Monitoring and Safety

• Continue to evaluate the balance between basal and bolus insulin; the total daily dose should be approximately 50% basal and 50% bolus when optimized 4, 5
• Consider further dose adjustments if glycemic targets are not achieved within 1-2 weeks 2, 7

Potential Pitfalls to Avoid

• Avoid excessive basal insulin without adequate mealtime coverage, which can lead to hypoglycemia between meals while still having postprandial hyperglycemia 3, 7
• Be cautious about rapid increases in insulin doses, which could lead to hypoglycemia; incremental adjustments are safer 3, 7