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Table 3 Algorithm for titration of premixed insulin‡[56]

From: Evidence-based clinical use of insulin premixtures

Preprandial blood glucose (mg/dL) Dose adjustment
<80 ↓ by 2
80-109 Maintain dose
110-139 ↑ by 2
140-179 ↑ by 4
≥180 ↑ by 6
  1. ‡This algorithm targets preprandial glucose ≤110 mg/dL to achieve a target A1C <7%, and can be used for patients using premixed insulin twice daily (BID) and 3 times daily (TID), including 3-day average blood glucose measurements.
  2. If BID - Adjust morning insulin dose based on the average predinner blood glucose and evening insulin dose based on the average prebreakfast/fasting blood glucose.
  3. If TID - Adjust morning insulin dose based on prelunch glucose levels, lunch insulin dose based on predinner glucose levels, and evening insulin dose based on prebreakfast/fasting glucose level.
  4. Do not increase dose in case of hypoglycemia (blood glucose <70 mg/dL) or its symptoms.