Insulin Dose Reduction for A1c 6.2%
Reduce both your basal and prandial insulin doses by 10-20% immediately—your A1c of 6.2% is below target and puts you at significant risk for hypoglycemia on your current regimen. 1
Immediate Dose Adjustments
Reduce your long-acting (basal) insulin from 28 units to 22-25 units daily (a 10-20% reduction). 1
Reduce your rapid-acting (prandial) insulin from 30 units to 24-27 units three times daily (a 10-20% reduction). 1
The 2025 American Diabetes Association guidelines explicitly state that when A1c is <8% and patients are meeting glucose targets, you should lower the basal dose by 4 units per day or 10% of basal dose to prevent hypoglycemia. 2, 1
Clinical Rationale for Dose Reduction
Your A1c of 6.2% is below the recommended target of <7% for most adults with diabetes, indicating potential overtreatment. 1, 3
Maintaining an A1c of 6.2% on high insulin doses (total daily dose of 118 units) significantly increases your risk of hypoglycemia, which can cause serious morbidity including cardiovascular events, falls, and impaired quality of life. 1
The American Diabetes Association recommends a target A1c range of 6.5-7.0% for optimal balance of glycemic control without excessive hypoglycemia risk. 1
Monitoring Strategy During Dose Adjustment
Check fasting glucose daily to guide basal insulin adjustments. 1
Check pre-meal glucose before each meal to guide prandial insulin adjustments. 1
Check 2-hour postprandial glucose after your largest meal to assess adequacy of prandial insulin coverage. 1
Increase monitoring frequency during dose adjustments to detect hypoglycemia early—this is non-negotiable for safe titration. 1
Recheck A1c in 3 months to ensure you remain in the optimal range of 6.5-7.0%. 1
Hypoglycemia Prevention and Management
Carry 15-20 grams of fast-acting carbohydrate at all times to treat blood glucose <70 mg/dL. 1
If hypoglycemia occurs despite dose reduction, decrease the corresponding insulin dose by an additional 10-20% immediately. 2, 1
For hypoglycemia episodes, determine the cause; if no clear reason exists, lower the dose by 10-20%. 2
Signs of Overbasalization to Monitor
Evaluate for these clinical signals that suggest excessive basal insulin: 2
- Elevated bedtime-to-morning glucose differential (glucose rising overnight despite adequate basal insulin)
- Elevated postprandial-to-preprandial glucose differential (large spikes after meals)
- Any hypoglycemia episodes (aware or unaware)
- High glucose variability (wide swings in glucose readings)
Alternative Therapy Consideration
If your A1c rises above 7% after dose reduction, consider adding a GLP-1 receptor agonist rather than increasing insulin doses. 2, 1
GLP-1 receptor agonists improve glycemic control while reducing insulin requirements and promoting weight loss, with lower hypoglycemia risk than insulin intensification. 2, 1
The American Diabetes Association recommends considering GLP-1 receptor agonists in combination with insulin when A1c remains above goal, and fixed-ratio combination products (such as insulin degludec/liraglutide or insulin glargine/lixisenatide) are available. 2
Target Glucose Ranges
Fasting plasma glucose target: 80-130 mg/dL 2
Postprandial glucose target: <180 mg/dL 2
These targets should guide your insulin dose adjustments while maintaining your A1c in the optimal 6.5-7.0% range. 1
Critical Pitfall to Avoid
Do not continue your current insulin doses unchanged—maintaining an A1c <6.5% on high insulin doses will inevitably lead to severe hypoglycemia, which carries significant morbidity and mortality risk. 1