basal-insulin-titration

name

basal-insulin-titration

description

Adjust basal insulin dose (Lantus, Basaglar, Ryzodeg/IDegAsp) based on fasting blood glucose trend. Use when a clinician asks how to titrate basal insulin, whether to increase or decrease Lantus/glargine/degludec/Ryzodeg dose, or how to adjust basal insulin based on fasting glucose readings. Triggers include: "adjust basal insulin", "titrate Lantus", "basal dose change", "FBG is high/low", "should I increase/decrease insulin".

Basal Insulin Titration — Proprietary Protocol

Step 1 — Gather the Data Points

Ask for (or confirm):

1. Yesterday's fasting blood glucose (FBG₋₁)
2. Today's fasting blood glucose (FBG₀)
3. Current basal insulin dose (in units)
4. Which basal insulin — Lantus (glargine U-100), Basaglar (glargine biosimilar), or Ryzodeg (IDegAsp, used OD as basal)

---

Step 2 — Determine the Trend

Compare FBG₀ vs FBG₋₁:

Trend	Definition
↑ Rising	FBG₀ > FBG₋₁
↓ Falling	FBG₀ < FBG₋₁
→ Stable	FBG₀ = FBG₋₁

---

Step 3 — Apply the Titration Rule

🔺 If FBG is RISING (FBG₀ > FBG₋₁) → INCREASE dose

Today's FBG (FBG₀)	Dose Adjustment
> 200 mg/dL	+4 units
90 – 200 mg/dL	+2 units
< 90 mg/dL	No change (at/below target — do not increase)

---

🔻 If FBG is FALLING (FBG₀ < FBG₋₁) → Usually NO CHANGE

Exception — reduce dose if FBG₀ is in hypoglycaemia range:

Today's FBG (FBG₀)	Dose Adjustment
≥ 90 mg/dL	No change
70 – 89 mg/dL	−2 units
< 70 mg/dL	−4 units

---

→ If FBG is STABLE → No change

---

Step 4 — State the New Dose

New dose = Current dose ± adjustment

State the insulin name and the specific new dose in units. Titrate daily.

---

Step 5 — Insulin-Specific Notes

Insulin	Generic Name	Titration
Lantus	Insulin glargine U-100	As per protocol above
Basaglar	Insulin glargine biosimilar	As per protocol above
Ryzodeg	IDegAsp (degludec + aspart)	As per protocol above

⚠️ Ryzodeg reminder: Contains both IDeg (basal) and IAsp (rapid-acting prandial component). When used OD as basal, the prandial component covers the injection meal. Counsel patient not to skip the meal at injection time.

---

Step 6 — Clinical Guardrails

• Nocturnal hypoglycaemia masking: A rising FBG₀ may indicate Somogyi-type rebound — check for overnight hypoglycaemia before increasing dose.
• Illness or reduced oral intake: Hold titration; consider empiric dose reduction.
• Renal impairment (eGFR < 30): Use ±2 units as maximum increment; hypoglycaemia risk amplified.
• Elderly patients: Use ±2 units as maximum increment regardless of glucose level.
• Basal insulin only. Prandial insulin titrated separately.

---

Quick Reference Card

FBG TODAY vs YESTERDAY
─────────────────────────────────────────────
TREND      │  FBG₀ VALUE    │  DOSE CHANGE
─────────────────────────────────────────────
↑ RISING   │  > 200 mg/dL   │  + 4 units
↑ RISING   │  90–200 mg/dL  │  + 2 units
↑ RISING   │  < 90 mg/dL    │  No change
→ STABLE   │  any           │  No change
↓ FALLING  │  ≥ 90 mg/dL    │  No change
↓ FALLING  │  70–89 mg/dL   │  − 2 units
↓ FALLING  │  < 70 mg/dL    │  − 4 units
─────────────────────────────────────────────
Titrate daily. Applies to Lantus, Basaglar, Ryzodeg.

---

Protocol: Proprietary — Mellitus Health Tech. For clinical use under physician supervision.