From the Guidelines
Basaglar titration should start with 10 units per day or 0.1-0.2 units/kg per day, with a goal of reaching the target fasting plasma glucose (FPG) level without hypoglycemia, as recommended by the 2025 standards of care in diabetes 1. When initiating Basaglar, it is essential to set an FPG goal and choose an evidence-based titration algorithm, such as increasing the dose by 2 units every 3 days until the target FPG level is achieved without hypoglycemia.
- Key considerations for Basaglar titration include:
- Starting dose: 10 units per day or 0.1-0.2 units/kg per day
- Titration algorithm: increase by 2 units every 3 days to reach FPG goal without hypoglycemia
- Hypoglycemia management: determine cause, and if no clear reason, lower dose by 10-20%
- Regular assessment of insulin dose adequacy and consideration of clinical signals for overbasalization or need for adjunctive therapies, as outlined in the 2025 standards of care in diabetes 1. It is crucial to monitor blood glucose levels regularly during titration and adjust the dose conservatively, especially in elderly patients or those with renal or hepatic impairment.
- Additional factors to consider during Basaglar titration include:
- Elevated bedtime-to-morning and/or postprandial-to-preprandial differential
- Hypoglycemia (aware or unaware)
- High glucose variability
- Potential need for adjunctive therapies, such as GLP-1 RA or dual GIP and GLP-1 RA, if A1C remains above goal, as recommended by the 2025 standards of care in diabetes 1.
From the Research
Basaglar Titration
- Basaglar is a type of basal insulin, and its titration is crucial in managing type 2 diabetes mellitus 2.
- The initiation dose of basal insulin is usually 10 units/day or 0.1-0.2 units/kg/day, and it should be titrated based on patients' self-measured fasting plasma glucose to achieve an individualized target 2.
- A simple rule for titrating basal insulin is to gradually increase the initial dose by 1 unit per day (for NPH, insulin detemir, and glargine 100 units/mL) or 2-4 units once or twice per week (for NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until FPG levels remain consistently within the target range 2.
- The dose of basal insulin should be increased as required up to approximately 0.5-1.0 units/kg/day in some cases, but overbasalization should be avoided 2.
- Studies have shown that adding basal insulin to metformin and/or sulfonylurea can be effective in reducing HbA1c levels in patients with type 2 diabetes mellitus 3, 4.
- Insulin glargine, in particular, has been shown to be effective in reducing HbA1c levels and improving glycemic control in patients with type 2 diabetes mellitus 5, 3, 4.
- However, insulin glargine may be associated with a higher risk of hypoglycemia compared to other treatments 3.