A BIDO regimen (bedtime insulin, daytime oral agent) may be used by a patient who is still hyperglycemic while receiving an oral hypoglycemic agent.


Patient selection: mild hyperglycemia while on maximal dose of an oral hypoglycemic agent AND preference to avoid a full insulin dosage regimen



(1) minimum number of fingersticks per day

(2) minimum number of insulin injections



(1) fasting glucose level in mg/dL for 2 days in a row

(2) body habitus (lean vs obese)


Insulin used: NPH or glarcine


The initial bedtime dose for a lean patient is 8 to 10 IU insulin. while for an obese patient it is 14 to 16 units.


Fasting Glucose (for 2 days in a row)

Lean Patient

Obese Patient

< 150 mg/dL on both days



>= 200 on both days

+2 units

2 times lean


+1 unit

2 times lean



(1) The fasting blood glucose values are accurate.

(2) The patient keeps accurate records and submits them to the provider regularly.

(3) The patient understands and can follow the algorithm.


To read more or access our algorithms and calculators, please log in or register.