Insulin Dosing Guidelines for First-Time Users

Recommended Basal Insulin Options

• The American Diabetes Association recommends long-acting basal insulins, such as insulin glargine (U-100 or U-300), detemir, degludec, or NPH insulin, for once-daily dosing 1, 3, 4
• Administer basal insulin at the same time every day, with morning administration recommended for simplicity and to reduce nocturnal hypoglycemia risk 1, 2, 3

Titration Protocol

• Monitor fasting finger-stick glucose values over one week, and increase the dose by 2 units if 50% of fasting values are above goal (90-150 mg/dL) 1, 2, 3
• Decrease the dose by 2 units if more than 2 fasting values per week are <80 mg/dL 1, 2, 3
• Reassess every 1-2 weeks until fasting glucose targets are achieved 1, 3

Critical Safety Considerations

• Avoid using rapid- or short-acting insulin at bedtime in first-time users or older adults to reduce nocturnal hypoglycemia risk 1, 2, 3

Monitoring Requirements

• Self-monitoring of fasting blood glucose is required for dose adjustment 1, 3

Special Population Considerations

• For older adults or those at high hypoglycemia risk, once-daily basal insulin is particularly appropriate due to minimal side effects and reduced complexity 2
• Consider adjusting fasting glucose goal based on overall health status and goals of care (can be more liberal than 90-150 mg/dL) 1, 2, 3