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the discrepancy between near-goal FPG and above goal HbA1c, Evaluate…
the discrepancy between near-goal FPG and above goal HbA1c
add prandial insulin analogs before the largest meal or greatest PPG
start 4 IU a day or 10% of basal dose
if HbA1c <8% lowering basal dose by 4 IU a day or 10% of basal dose
titrate-up 1-2 IU or 10-15% twice weekly
lower dose by 10-20%
Add GLP-1 RA
if on bedtime NPH
total dose: 80% of current dose
twice-daily NPH
2/3 morning
if HBA1C above target
1/3 bedtime
Evaluate overbasalization and need to consider adjunctive therapies
basal dose > 0.5 IU/kg
elevated bedtime-morning differential
elevated post-preprandial differential
hypoglycemia
hypoglycemia
if HbA1c above target
additional prandial insulin
full basal-bolus
twice daily premix insulin