Key Recommendations for Titration Regimen in Practice (How to Titrate Basal Insulin?)

A once-weekly titration regimen should be adopted in which up-titration is by 2 units until the FPG levels are between 90 and 120 mg/dL and down-titration is by 2 units when the FPG levels are < 90 mg/dL. This regimen may be a simple and effective method in the Indian context; where possible insulin dose can also be titrated 2 units every 3 days

The recommended maximum daily dose of basal insulin is 0.5 units/kg body weight. The maximum average daily dose of basal insulin titration in the Indian context is 30 units although the panel did note that there is no strict maximum dose for basal insulin. This recommendation was based on the clinical experience of the expert panel

Person/caregiver injection techniques should be reviewed at the first visit and at every follow-up visit

Log books and mobile apps are useful tools to help the patient keep a record of the titration process

Once-a-month follow-up is recommended until optimal dose of basal insulin is achieved

Documenting episodes of hypoglycemia and maintaining a symptom diary may help persons with type 2 diabetes mellitus (T2DM) overcome the fear of hypoglycemia during the titration period