Although switching between basal insulins is usually easily accomplished, pharmacokinetic and pharmacodynamic differences between formulations require clinicians to provide explicit guidance to patients.

travel, dietary change, illness, hospitalization, etc.). Through a shared decision-making process, confirmation of appropriate goals and titration methods should be established, including provisions for events that might alter scheduled titration (e.g. Basal insulin is usually initiated at a conservative dose of 10 units/day or 0.1–0.2 units/kg/day, then titrated thereafter over several weeks or months, based on patients’ self-measured fasting plasma glucose, to achieve an individualized target (usually 80–130 mg/dL). Newer, long-acting basal insulins provide greater stability and flexibility than older preparations and improved delivery systems. Since most people with type 2 diabetes are managed in the community, it is important that primary care providers understand and correctly manage the initiation and titration of basal insulins, and help patients to self-manage insulin injections. Many patients with type 2 diabetes will ultimately require the inclusion of basal insulin in their treatment regimen.