As an adult with type 2 diabetes on empagliflozin/linagliptin (Jordiance) 25 mg daily, rapid‑acting insulin (Human insulin) 4–6 units before meals, and basal insulin glargine (Lantus) 18 units in the morning, how should I adjust my insulin regimen to correct nocturnal hyperglycemia (bedtime glucose 300 mg/dL) while avoiding fasting hypoglycemia (symptomatic when glucose <100 mg/dL)?

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Last updated: February 14, 2026 • View editorial policy

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Immediate Insulin Regimen Adjustment for Nocturnal Hyperglycemia with Fasting Hypoglycemia Risk

Increase your morning Lantus dose by 4 units every 3 days until fasting glucose consistently reaches 80–130 mg/dL, and add 4 units of Humalog before your largest meal to address the 9 PM hyperglycemia. 1

Understanding Your Current Problem

Your situation reflects two distinct issues that require separate solutions:

  • Fasting glucose averaging 106 mg/dL with symptomatic hypoglycemia below 100 mg/dL indicates your basal insulin (Lantus 18 units in the morning) is marginally adequate but may be causing nocturnal hypoglycemia. 1

  • Bedtime glucose of 300 mg/dL signals profound inadequacy of your prandial insulin coverage (Humalog 4–6 units before meals), not a basal insulin problem. 1

  • The American Diabetes Association emphasizes that basal insulin controls fasting and between-meal glucose, while prandial insulin addresses post-meal excursions—these are independent components that must be titrated separately. 1

Immediate Basal Insulin (Lantus) Adjustment

Titration Protocol

  • Increase Lantus by 4 units every 3 days when fasting glucose is ≥180 mg/dL (though your fasting is 106 mg/dL, the bedtime hyperglycemia suggests inadequate overnight basal coverage). 1

  • Target fasting glucose: 80–130 mg/dL. 1

  • If you experience hypoglycemia (glucose <70 mg/dL) without a clear cause, reduce the Lantus dose by 10–20% immediately. 1

Critical Threshold Warning

  • When your Lantus dose approaches 0.5 units/kg/day (approximately 36–40 units for a typical adult), stop escalating basal insulin and focus on intensifying prandial insulin to avoid "over-basalization" with increased hypoglycemia risk. 1

  • Clinical signals of over-basalization include: basal dose >0.5 units/kg/day, bedtime-to-morning glucose drop ≥50 mg/dL, hypoglycemia episodes, and high glucose variability. 1

Addressing the 9 PM Hyperglycemia: Add Prandial Insulin

Why Your Current Humalog Dose Is Insufficient

  • A bedtime glucose of 300 mg/dL clearly indicates inadequate prandial insulin coverage, not a basal insulin problem. 1

  • The American Diabetes Association states that basal insulin does not address post-meal hyperglycemia—continuing to increase Lantus will only increase hypoglycemia risk without improving bedtime glucose. 1

Prandial Insulin Initiation

  • Start with 4 units of Humalog before your largest meal (typically dinner, which likely precedes your 9 PM reading). 1

  • Alternatively, use 10% of your current basal dose (approximately 2 units based on 18 units Lantus), though 4 units is more appropriate given the severity of your bedtime hyperglycemia. 1

  • Administer Humalog 0–15 minutes before meals for optimal post-prandial control. 1

Prandial Insulin Titration

  • Increase the dinner Humalog dose by 1–2 units every 3 days based on your bedtime glucose reading (2 hours post-dinner). 1

  • Target bedtime glucose: <180 mg/dL. 1

  • If hypoglycemia occurs, reduce the implicated dose by 10–20%. 1

Managing Your Symptomatic Hypoglycemia Below 100 mg/dL

Immediate Treatment Protocol

  • Treat any glucose <70 mg/dL immediately with 15 grams of fast-acting carbohydrate (glucose tablets, 4 oz juice, or 3–4 glucose tablets), recheck in 15 minutes, and repeat if needed. 1

  • Your symptom threshold of 100 mg/dL suggests hypoglycemia unawareness—your body's warning signals have shifted higher, making you more vulnerable to severe hypoglycemia. 1

Adjusting for Hypoglycemia Unawareness

  • Temporarily raise your fasting glucose target to 100–150 mg/dL by reducing Lantus by 2–4 units until hypoglycemia awareness improves. 1

  • Scrupulous avoidance of hypoglycemia for 2–3 weeks can reverse hypoglycemia unawareness if present. 2

  • Always carry fast-acting carbohydrates and check glucose before driving or activities where hypoglycemia would be dangerous. 1

Role of Your Jardiance (Empagliflozin/Linagliptin 25 mg)

Complementary Glucose-Lowering Without Hypoglycemia

  • Jardiance (empagliflozin/linagliptin) provides insulin-independent glucose lowering through renal glucose excretion (SGLT2 inhibition) and enhanced incretin activity (DPP-4 inhibition). 3, 4

  • Empagliflozin added to basal insulin reduces HbA1c by approximately 0.6–0.7% without increasing hypoglycemia risk compared to placebo. 5

  • Continue Jardiance 25 mg daily—it complements your insulin regimen by reducing glucose reabsorption in the kidneys and enhancing insulin secretion in response to meals. 6, 7

Important Safety Considerations

  • Jardiance causes osmotic diuresis and mild blood pressure reduction—monitor for symptoms of volume depletion (dizziness, lightheadedness) especially when increasing insulin doses. 3

  • Genital mycotic infections occur more frequently (especially in women)—maintain good hygiene and report any symptoms. 3

  • Jardiance efficacy decreases with renal impairment—ensure your kidney function is monitored regularly. 3

Monitoring Requirements During Titration

Daily Glucose Checks

  • Check fasting glucose every morning to guide Lantus adjustments. 1

  • Check bedtime glucose (2 hours after dinner) to guide dinner Humalog adjustments. 1

  • Check pre-meal glucose before each meal to calculate correction doses if needed. 1

When to Contact Your Provider

  • Fasting glucose remains >180 mg/dL after 2–3 weeks of titration. 1

  • Lantus dose exceeds 0.5 units/kg/day (approximately 36–40 units for most adults) without achieving fasting glucose targets. 1

  • Any glucose <70 mg/dL or symptomatic hypoglycemia. 1

  • Bedtime glucose remains >250 mg/dL after adding dinner Humalog. 1

Common Pitfalls to Avoid

Do Not Continue Escalating Lantus Alone

  • Increasing Lantus beyond 0.5–1.0 units/kg/day without addressing post-meal hyperglycemia leads to over-basalization with increased hypoglycemia risk and suboptimal control. 1

  • Your bedtime glucose of 300 mg/dL requires prandial insulin, not more basal insulin. 1

Do Not Use Correction Doses at Bedtime

  • Never administer Humalog at bedtime as a sole correction dose—this markedly increases nocturnal hypoglycemia risk. 1, 2

  • Rapid-acting insulin has a peak action at 1–3 hours and duration of 3–5 hours, meaning bedtime administration creates maximum insulin effect during sleep when counter-regulatory responses are blunted. 2

Do Not Delay Adding Prandial Insulin

  • When bedtime glucose consistently exceeds 250 mg/dL, delaying prandial insulin addition prolongs hyperglycemia exposure and increases complication risk. 1

Expected Outcomes with Proper Regimen

  • With appropriately titrated basal-bolus therapy, approximately 68% of patients achieve mean glucose <140 mg/dL versus only 38% with inadequate regimens. 1

  • HbA1c reduction of 2–3% is achievable within 3–6 months with proper insulin intensification. 1

  • Properly implemented basal-bolus regimens do not increase hypoglycemia incidence compared with inadequate approaches when titrated correctly. 1

Reassessment Schedule

  • Every 3 days during active titration to adjust Lantus and dinner Humalog doses. 1

  • Every 3–6 months once stable to reassess overall glycemic control and HbA1c. 1

  • Consider adding prandial insulin to other meals if HbA1c remains above target after 3–6 months despite achieving fasting and bedtime glucose goals. 1

References

1
Guideline

Initial Dosing for Lantus (Insulin Glargine) in Patients Requiring Insulin Therapy

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Fiasp Administration and Nocturnal Hypoglycemia Risk

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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