Adjusting ("Titrating") Insulin

How to Titrate (Adjust) Your Insulin

Goals:

Fasting blood glucose (first thing in the morning, before meals): Between 90-130

Postprandial glucose (1-2 hours after eating): 180

HgA1c (checked every 3 months): <7.0

Difference between fasting and postprandial glucose: <50

Self-Titrating Insulin at Home:

Check fasting glucose (blood sugar on an empty stomach) daily

Insulin can be increased or decreased based on following numbers every 3-7 days, discuss with your doctor the best regimen for you

Fasting glucose

• 120-140 --> Increase in basal (long-acting) insulin 2 units

• 141-160 --> Increase in basal insulin 4 units

• 161-180 --> Increase in basal insulin 6 units

• 181-200 --> Increase in basal insulin 8 units

• >200 --> Increase in basal insulin 10 units and call your doctor to let them know what you're doing.​

When fasting blood sugars are under control, monitor your blood sugars after meals. If these continue to be persistently elevated or there is a difference of <50 units between your fasting blood glucose and postprandial glucose, your provider may need to add insulin with meals.

Signs and symptoms of hypoglycemia (low blood sugar):

Shakiness

Dizziness

Sweating

Hunger

Irritability/mood changes

Headache

Damp sheets when you wake up

If any of above symptoms happen—take your blood sugar:

If < 70 → take 15 grams of carbohydrate (1/2 a cup of juice or 2-4 sugar candies)

Check in 15 minutes

If still <70→another 15 grams of carbohydrate (1/2 cup of juice or 2-4 sugar candies)

Continue until sugar >70, alert your healthcare provider

Serious signs of hypoglycemia:

Clumsiness or weakness

Slurred speech/difficulty speaking

Blurry/double vision

Drowsiness/Confusion

Seizures

Unable to wake

If you notice the above symptoms or signs, call your doctor or go to the emergency room immediately