From the Guidelines
Long-acting basal analogs such as U-100 glargine or degludec are good options to convert to from other basal insulins, considering their reduced risk of nocturnal hypoglycemia. When converting from one basal insulin to another, it is essential to understand the conversion process to maintain glycemic control. According to the 2025 standards of care in diabetes 1, attainment of fasting glucose goals can be achieved with human NPH insulin or a long-acting insulin analog.
Key considerations for conversion include:
- Unit-for-unit conversion is often possible, with subsequent adjustments based on glucose monitoring
- An initial dose reduction of 10–20% may be necessary for individuals in very tight management or at high risk for hypoglycemia, particularly when switching from insulin detemir or U-300 glargine to another insulin 1
- Clinicians should be aware of the potential for overbasalization, which can mask insufficient mealtime insulin, and evaluate for clinical signals such as high bedtime-to-morning or preprandial-to-postprandial glucose differential, hypoglycemia, and high glucose variability 1
In clinical practice, the choice of insulin should be individualized based on patient factors, such as glucose control, hypoglycemia risk, and insurance coverage. The most recent evidence suggests that longer-acting basal analogs like U-300 glargine or degludec convey a lower nocturnal hypoglycemia risk than U-100 glargine 1. Therefore, when converting from another basal insulin, these options should be considered to optimize glycemic control and minimize the risk of hypoglycemia.
From the Research
Insulin Conversion Options
When converting from one insulin to another, several factors must be considered, including the type of diabetes, current insulin regimen, and individual patient needs.
- Insulin degludec and insulin degludec/insulin aspart are ultra-long-acting insulin analogues that have been shown to provide sustained glycaemic control with less hypoglycaemia and the potential for a simpler insulin regimen with fewer daily injections 2, 3.
- Insulin aspart is a rapid-acting insulin analogue that can be used in combination with basal insulins, such as insulin detemir, to provide effective glycaemic control 4, 5.
- The choice of insulin analogue depends on the individual patient's needs and circumstances, and should be made in consultation with a healthcare professional.
Key Considerations
When converting to a new insulin, the following factors should be considered:
- The patient's current insulin regimen and dosage
- The patient's glycaemic control and treatment goals
- The potential for hypoglycaemia and other side effects
- The simplicity and convenience of the new insulin regimen
Available Insulin Options
Some available insulin options for conversion include:
- Insulin degludec (ultra-long-acting)
- Insulin degludec/insulin aspart (co-formulation of ultra-long-acting and rapid-acting insulins)
- Insulin aspart (rapid-acting)
- Insulin detemir (long-acting)
- Insulin glargine (long-acting)
It is essential to consult with a healthcare professional to determine the best insulin option for each individual patient, as the most suitable choice will depend on their specific needs and circumstances 2, 3, 4, 5, 6.