Riddle et al developed a schedule for titrating insulin doses in type 2 diabetic that would achieve a given target fasting plasma glucose ("treat-to-target"). This can result in effective insulin therapy while minimizing the risk of adverse side effects. The authors are from the Insulin Glargine 4002 Study Investigators.



(1) mean of self-monitored fasting plasma glucose values over past 2 days

(2) severe hypoglycemia in preceding week (defined as need for assistance)

(3) minimum plasma glucose during past week


Initial dose of insulin: 10 IU per day at bedtime


Target fasting plasma glucose: 72 - 100 mg/dL


Mean Fasting Plasma Glucose for Past 2 Day

Increase Over Previous Daily Dose

>= 180 mg/dL

8 IU per day

140 - 179 mg/dL

6 IU per day

120 - 139 mg/dL

4 IU per day

101 - 119 mg/dL

2 IU per day

72 - 100 mg/dL

no change



Minimum Fasting Glucose in Past Week

Severe Hypoglycemia Episode in Past Week

Change in Insulin Dose

56 to 71 mg/dL


no change

< 56 mg/dL


reduce dose 2-4 IU per day



reduce dose 2-4 IU per day


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