From the Guidelines
For a patient with an HbA1c of 9% taking HumaLOG Mix 75/25 (Insulin Lispro Protamine/Insulin Lispro) 30 units and Lantus SoloStar (Insulin Glargine) 30 units, a 2-unit increase every 3 days is recommended to reach the FPG goal without hypoglycemia, as suggested by the 2025 standards of care in diabetes 1. To implement this, the patient's current dose of HumaLOG Mix 75/25 and Lantus SoloStar can be increased by 2 units every 3 days, monitoring closely for signs of hypoglycemia or excessive glucose variability.
- Key considerations include:
- Setting an appropriate FPG goal, as outlined in the standards of care 1.
- Choosing an evidence-based titration algorithm to guide dose adjustments.
- Regularly assessing the adequacy of the insulin dose and considering clinical signals for overbasalization or the need for adjunctive therapies. Given the patient's current HbA1c level, indicating poor glycemic control, careful and gradual adjustments to the insulin regimen are necessary to avoid hypoglycemia while working towards achieving target glucose levels.
- Monitoring should include checking blood glucose levels at least 2-4 times daily during the adjustment period. The patient should follow up with their healthcare provider in 2-4 weeks to evaluate the effectiveness of the dose changes and make further adjustments as needed, based on the clinical response and glucose monitoring data.
From the Research
Insulin Dose Adjustment for Patient with HbA1c 9%
The patient is currently taking HumaLOG Mix 75/25 (Insulin Lispro Protamine/Insulin Lispro) 30 units and Lantus SoloStar (Insulin Glargine) 30 units. To determine the recommended increase in insulin dose, we need to consider the patient's current HbA1c level and the treatment goals.
- The American Association of Clinical Endocrinologists and the American Diabetes Association recommend considering insulin administration for people with type 2 diabetes with HbA1c levels exceeding 9.0% and 10%, respectively 2.
- A study published in 2017 suggests that short-term intensive insulin therapy could be the preferred option for new-onset type 2 diabetes mellitus patients with HbA1c > 9% 3.
- Another study published in 2018 recommends individualizing the treatment approach to glucose control, considering factors such as age, health behaviors, comorbidities, and life expectancy 4.
- A retrospective cohort study published in 2025 found that simplifying complex insulin regimens can improve glycometabolic parameters and target organ damage in type 2 diabetes patients 5.
- A study published in 2013 found that switching to basal-bolus insulin therapy is effective and safe in long-term type 2 diabetes patients inadequately controlled with other insulin regimens 6.
Recommended Insulin Dose Adjustment
Based on the available evidence, it is recommended to:
- Increase the insulin dose gradually, taking into account the patient's response to treatment and potential risk of hypoglycemia.
- Consider simplifying the insulin regimen to improve adherence and reduce the risk of hypoglycemia.
- Monitor the patient's HbA1c levels regularly to adjust the insulin dose as needed.
- Consider adding other glucose-lowering therapies, such as metformin or GLP-1 receptor agonists, to improve glycemic control.
Some possible insulin dose adjustments could be:
- Increase the HumaLOG Mix 75/25 dose by 10-20% every 3-4 days, based on the patient's blood glucose levels and response to treatment.
- Increase the Lantus SoloStar dose by 10-20% every 1-2 weeks, based on the patient's blood glucose levels and response to treatment.
- Consider switching to a basal-bolus insulin regimen, with a basal insulin dose of 20-30 units and a bolus insulin dose of 10-20 units, based on the patient's meal plan and physical activity level.