Starting basal insulin (bedtime NPH or glargine): use an initial dose of 10 to 20 U or 0.1 to 0.2 U per kg (a higher dose can be used in poorly controlled patients).

Adjusting basal insulin: increase the dose by 4 U if fasting CBG level is higher than 140 mg per dL (7.8 mmol per L) on three consecutive measures or by 2 U if fasting CBG level is 110 to 140 mg per dL (6.1 to 7.8 mmol per L) on three consecutive measures.

Most patients with type 2 diabetes need a total daily dosage of 1 to 1.2 U per kg to achieve an A1c level of less than 7 percent (basal dose, 0.5 to 0.6 U per kg per day).

Converting from an existing regimen: divide total daily insulin need by two and use that as the basal dose (some experts recommend decreasing the starting basal dose by 20 percent to decrease the risk of hypoglycemia). Alternatively, in a patient already taking NPH or ultralente who is being switched to insulin glargine, use approximately 80 percent of the NPH or ultralente dose as glargine.