Practice question from Insulin Dosing & Titration

An adult patient with type 2 diabetes is receiving insulin glargine 30 units once daily. Over the past 3 consecutive mornings, the patient’s fasting blood glucose has averaged 165 mg/dL. The target fasting glucose range is 80–130 mg/dL. Using ADA-recommended outpatient treat-to-target basal insulin titration guidelines, what is the most appropriate adjustment? A. Increase by 2 units B. Increase by 4 units C. Increase by 6 units D. Increase by 8 units E. No change needed

Answer

B

Explanation

According to ADA-recommended outpatient treat-to-target basal insulin titration guidelines, a fasting blood glucose level between 140 and 180 mg/dL warrants an increase in basal insulin by 4 units after consistent elevations over multiple days. Because the patient’s fasting glucose has averaged 165 mg/dL for 3 consecutive mornings, an increase of 4 units of insulin glargine is appropriate. This conservative, stepwise adjustment helps optimise glycemic control while minimizing the risk of hypoglycemia.

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