What is a good time to take basal insulin?

From the Guidelines

The best time to take basal insulin is in the morning, using 70% of the total dose as basal, as recommended by the most recent guidelines 1. This approach is supported by the latest research, which emphasizes the importance of individualizing insulin therapy based on a patient's specific needs and blood glucose patterns.

Key Considerations

• The timing of basal insulin administration should be consistent and tailored to the individual's lifestyle and glucose control goals.
• The use of 70% of the total dose as basal in the morning is a recommended approach, as it helps to simplify complex insulin regimens and improve glucose control 1.
• It is essential to titrate the dose of basal insulin based on fasting finger-stick glucose test results over a week, with a goal of achieving a fasting glucose level between 90-150 mg/dL (5.0-8.3 mmol/L) 1.
• If 50% of the fasting finger-stick glucose values are over the goal, the dose should be increased by 2 units, and if more than 2 fasting finger-stick values per week are below 80 mg/dL (4.4 mmol/L), the dose should be decreased by 2 units 1.

Additional Guidance

• The choice of basal insulin should be based on the individual's specific needs and preferences, with options including Lantus (insulin glargine), Levemir (insulin detemir), Tresiba (insulin degludec), and Toujeo (concentrated insulin glargine).
• Regular monitoring of blood glucose levels is crucial to ensure proper dosing and timing of basal insulin, and to minimize the risk of hypoglycemia and other complications.
• Healthcare providers should work closely with patients to individualize their insulin regimens and provide ongoing support and guidance to optimize glucose control and overall health outcomes.

From the FDA Drug Label

In two clinical studies (Studies A and B), adult patients with type 1 diabetes (Study A, n=585, Study B n=534) were randomized to 28 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. Regular human insulin was administered before each meal Insulin Glargine was administered at bedtime. In another clinical study (Study C), patients with type 1 diabetes (n=619) were randomized to 16 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. Insulin lispro was used before each meal. Insulin Glargine was administered once daily at bedtime and NPH insulin was administered once or twice daily. In a randomized, controlled clinical study (Study D), pediatric patients (age range 6 to 15 years) with type 1 diabetes (n=349) were treated for 28 weeks with a basal-bolus insulin regimen where regular human insulin was used before each meal. Insulin Glargine was administered once daily at bedtime and NPH insulin was administered once or twice daily. In a randomized, controlled clinical study (Study E) in 570 adults with type 2 diabetes, Insulin Glargine was evaluated for 52 weeks in combination with oral antidiabetic medications (a sulfonylurea, metformin, acarbose, or combinations of these drugs). Insulin Glargine administered once daily at bedtime was as effective as NPH insulin administered once daily at bedtime in reducing HbA1c and fasting glucose.

A good time to take basal insulin, specifically Insulin Glargine, is at bedtime, as administered in the clinical studies [ 2 ]. This dosing schedule was used in both type 1 and type 2 diabetes patients, and was found to be effective in reducing HbA1c and fasting glucose levels. Key points to consider:

• Administration time: at bedtime
• Type of diabetes: effective for both type 1 and type 2 diabetes
• Efficacy: reduces HbA1c and fasting glucose levels

From the Research

Basal Insulin Administration Timing

The optimal time to take basal insulin can vary depending on the type of insulin and individual patient needs.

• Studies have shown that bedtime administration of intermediate-acting insulin can result in improved basal glycemia and overall metabolic control compared to morning administration 3.
• However, other studies have found that insulin glargine, a long-acting human insulin analog, can be administered at bedtime, dinner, or even before breakfast with similar efficacy in controlling blood glucose levels 4, 5.
• The choice of administration time may depend on the specific insulin regimen and patient factors, such as lifestyle and meal patterns.
• For example, one study found that administering glargine at dinnertime or bedtime resulted in lower mean daily blood glucose levels and improved HbA1c control compared to administering NPH insulin four times a day 5.
• Another study suggested that optimizing the evening insulin dose by reducing the premeal lispro dose and increasing the bedtime basal NPH dose can improve evening and nighttime glycemic control 6.

Key Considerations

• The timing of basal insulin administration should be individualized based on patient needs and response to therapy.
• Factors such as meal patterns, physical activity, and glucose monitoring data should be taken into account when determining the optimal administration time.
• Healthcare providers should work with patients to find the best basal insulin regimen and administration schedule to achieve optimal glycemic control and minimize hypoglycemia risk 4, 3, 7, 5, 6.