Insulin Glargine Dose Adjustment for 217-Pound Patient
For a patient weighing 217 pounds (98.6 kg), start insulin glargine at 10 units per day OR use weight-based dosing of 0.1-0.2 units/kg per day, which equals 10-20 units daily, then titrate systematically based on fasting glucose values. 1
Initial Dosing Strategy
The 2025 American Diabetes Association guidelines provide two equivalent starting approaches for basal insulin initiation 1:
- Fixed dose: Start 10 units per day
- Weight-based dose: 0.1-0.2 units/kg per day
- For 217 pounds (98.6 kg): 10-20 units daily
- Conservative approach: Start at 10 units
- More aggressive approach: Start at 15-20 units if A1C >10% or glucose ≥300 mg/dL
Titration Algorithm
Use an evidence-based titration protocol to reach fasting plasma glucose goal without hypoglycemia 1:
- Increase by 2 units every 3 days until fasting glucose target is achieved 1
- Target fasting glucose: <100 mg/dL (5.5 mmol/L) for optimal A1C control 2
- More aggressive option: Patient-managed titration increasing 2 units every 3 days (shown to achieve greater A1C reductions) 2
Alternative Titration Approaches
The Treat-to-Target algorithm adjusts based on 3-day mean fasting glucose 2:
- If fasting glucose ≥180 mg/dL: increase by 6-8 units
- If fasting glucose 140-179 mg/dL: increase by 4 units
- If fasting glucose 120-139 mg/dL: increase by 2 units
- If fasting glucose 100-119 mg/dL: increase by 0-2 units
Dose Reduction Scenarios
For hypoglycemia: Determine the cause; if no clear reason identified, lower dose by 10-20% 1
When adding prandial insulin: If A1C <8%, consider reducing basal insulin by 4 units or 10% to prevent hypoglycemia 1, 3
When switching between basal insulins: Most conversions are unit-for-unit, but reduce by 10-20% when switching from insulin detemir or U-300 glargine to standard glargine for patients in tight control or at high hypoglycemia risk 1
Monitoring for Overbasalization
Watch for clinical signals indicating excessive basal insulin 1:
- Bedtime-to-morning glucose differential ≥50 mg/dL
- Hypoglycemia (aware or unaware)
- High glucose variability
- Elevated postprandial glucose despite controlled fasting glucose
If overbasalization is present, do not continue increasing glargine—instead add GLP-1 RA or prandial insulin to address postprandial hyperglycemia 1
Practical Considerations
- Glargine can be administered at any time of day, though bedtime is traditional 4, 5
- In labile diabetes or very insulin-resistant patients, consider twice-daily glargine dosing if once-daily causes hypoglycemia despite titration 6, 4
- Assess insulin adequacy at every visit and adjust based on glucose monitoring 1