How to Check if You Need to Increase Insulin by 2 Units
Increase your basal insulin dose by 2 units if 50% or more of your fasting fingerstick glucose values over one week are above your target goal of 90-150 mg/dL (5.0-8.3 mmol/L). 1
Monitoring Protocol for Basal Insulin Adjustment
For Basal (Long-Acting) Insulin Titration
- Check fasting fingerstick glucose daily for one week before making any dose adjustments 1
- Count how many fasting values exceed your target range (typically 90-150 mg/dL) 1
- If ≥50% of fasting values are above goal: increase the basal insulin dose by 2 units 1
- Target may be adjusted based on overall health status and individual goals of care, particularly in older adults where higher targets may be appropriate to minimize hypoglycemia risk 1, 2
Safety Check Before Increasing
Do NOT increase insulin if you have had >2 fasting fingerstick values per week <80 mg/dL (<4.4 mmol/L) - instead, you should decrease the dose by 2 units to prevent dangerous hypoglycemia 1
Monitoring Protocol for Prandial (Mealtime) Insulin
For Premeal Insulin Adjustments
- Check fingerstick glucose before lunch and before dinner over a 2-week period 1
- Target premeal glucose: 90-150 mg/dL (5.0-8.3 mmol/L) 1
- If 50% of premeal values over 2 weeks are above goal: increase the dose or add another glucose-lowering agent 1
- If >2 premeal values per week are <90 mg/dL (<5.0 mmol/L): decrease the medication dose 1
Critical Timing Considerations
The timing of glucose checks must match the insulin type being adjusted:
- Basal insulin adjustments: based on fasting (morning) glucose values over 1 week 1
- Prandial insulin adjustments: based on premeal glucose values over 2 weeks 1
- Increase frequency of blood glucose monitoring during any insulin regimen changes 3
Common Pitfalls to Avoid
- Don't adjust too quickly: Basal insulin requires one full week of data; prandial insulin requires two weeks 1
- Don't ignore hypoglycemia: Even one or two low readings per week (<80 mg/dL fasting or <90 mg/dL premeal) should prompt dose reduction, not increase 1
- Don't use the wrong glucose reading: Fasting glucose guides basal insulin; premeal glucose guides prandial insulin 1
- Don't make adjustments without medical supervision when possible, especially during initial titration phases 3