Basaglar Dose Titration Guidelines
Increase Basaglar by 2-4 units every 3 days based on your fasting blood glucose levels: add 2 units if fasting glucose is 140-179 mg/dL, or add 4 units if fasting glucose is ≥180 mg/dL, until you reach a target of 80-130 mg/dL. 1
Standard Titration Algorithm
The American Diabetes Association provides a clear, evidence-based approach to Basaglar (insulin glargine) dose adjustment 1:
- If fasting glucose is 140-179 mg/dL: Increase by 2 units every 3 days 1
- If fasting glucose is ≥180 mg/dL: Increase by 4 units every 3 days 1
- Target fasting glucose: 80-130 mg/dL 1
- If hypoglycemia occurs: Reduce dose by 10-20% immediately 1
Alternatively, you can use a percentage-based approach: increase by 10-15% of the current dose once or twice weekly until fasting blood glucose targets are met 1. This translates to roughly 2-4 units for most patients 1.
Critical Threshold: When to Stop Escalating Basal Insulin
When your Basaglar dose exceeds 0.5 units/kg/day and approaches 1.0 units/kg/day, stop increasing basal insulin and add prandial (mealtime) insulin instead. 1 Continuing to escalate basal insulin beyond this threshold leads to "overbasalization"—a dangerous pattern causing increased hypoglycemia without improved glucose control 1.
Clinical Signs You've Reached the Threshold
Watch for these warning signs that indicate you need prandial insulin, not more Basaglar 1:
- Basal insulin dose >0.5 units/kg/day 1
- Large difference between bedtime and morning glucose (≥50 mg/dL) 1
- Hypoglycemia episodes 1
- High glucose variability throughout the day 1
- Fasting glucose controlled but A1C remains elevated after 3-6 months 1
Adding Prandial Insulin When Needed
If Basaglar alone doesn't achieve A1C goals despite reaching fasting glucose targets, start prandial insulin with 4 units before the largest meal or 10% of your current basal dose 2, 1. This addresses postprandial (after-meal) hyperglycemia that basal insulin cannot control 2.
Monitoring Requirements
- Daily fasting blood glucose monitoring is essential during titration 1
- Reassess every 3 days during active dose adjustments 1
- Check A1C every 3-6 months once stable 1
Common Pitfalls to Avoid
Do not wait longer than 3 days between dose adjustments in stable patients—this unnecessarily delays achieving glycemic targets 1. However, if you experience hypoglycemia, reduce the dose immediately by 10-20% rather than waiting for the next scheduled adjustment 1.
Do not continue escalating Basaglar beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia—this leads to suboptimal control and increased hypoglycemia risk 1. Blood glucose elevations throughout the day likely reflect inadequate mealtime insulin coverage, not insufficient basal insulin 1.
Continue metformin unless contraindicated when adding or intensifying insulin therapy, as it reduces total insulin requirements and provides complementary glucose-lowering effects 1.
Special Considerations
For patients with severe hyperglycemia (A1C ≥9%, blood glucose ≥300-350 mg/dL), more aggressive titration with 4-unit increments may be appropriate from the start 1. In elderly patients, those with renal failure, or those with poor oral intake, use lower starting doses (0.1-0.25 units/kg/day) and titrate more cautiously 1.
The real-world evidence confirms that Basaglar and Lantus have equivalent dosing and glycemic outcomes, so these titration guidelines apply equally to both formulations 3.