Table 8.

Starting and titrating insulin therapy

	Starting capacity	Scaling	Hypoglycemia
Basal insulin	10 units/day or 0.1–0.2 units/kg/day	To achieve the target fasting glucose level, increments of 2 units every 3 days (other proven titration methods are available)	Analyze the cause; consider 10%–20% reduction without any specific cause
Mealtime insulin	Start with 4 units/day, or 10% of basal insulin; consider 4 units/day or a 10% reduction of basal insulin when A1c <8%	1–2 units twice a week or 10%–15% increase	Analyze the cause; consider 10%–20% reduction without any specific cause
Mixed insulin	If use insulin for the first time, 10–12 units/day or 0.3 units/kg/day	1–2 units once or twice a week, or 10%–15% increase	Analyze the cause; consider 2–4 units or 10%–20% reduction without any specific cause
	Split the basal insulin dose to dosing with 2/3 in the morning and 1/3 in the afternoon; or half and half in the morning and the afternoon

Adapted from Wu et al. [308].