Medication Chart For Type 2 Diabetes Page 3
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4Medication Chart for Type 2 Diabetes
page 3 of 4
Insulin Titration Algorithm for NPH
Start with PM or bedtime NPH 10 units
or 0.2 units per kg
Increase dose by 2 units q 3 days until fasting levels
are 70-130 mg/dl; can increase dose by 4 units q
3 days if fasting glucose >180 mg/dl
A1c <7% after 3 months?
If hypoglycemia occurs,
No
or fasting glucose level
Yes
<70 mg/dl, reduce
bedtime dose by
Check BG pre-dinner.
≥4 units, or
Is pre-dinner BG >150 mg/dl?
10% if dose >60 units
No
Yes
Add AM NPH 10 units. Can
Check BG pre-lunch and at
increase dose by 4 units q 3 days if
bedtime. Is pre-lunch or bedtime
pre-dinner BG >180mg/dl
BG >150?
No
Yes
No
A1c <7% after 3 months?
Yes
Add 4 units Regular or short acting analog insulin
at breakfast for high pre-lunch BG, or at dinner
for high bedtime BG
; can increase meal-specific
1,2
dose by 2 units every 7 days if BG >180
Continue
regimen; check
A1c q 6 months
Yes
A1c <7% after 3 months?
No
Check 2 hour postprandial levels and adjust pre-prandial
Regular or short acting analog insulin
1. Sulfonylurea should be discontinued when Regular or short acting analog insulin is started.
2. For ease of dosing, Regular or short acting analog insulin can be combined with NPH at breakfast and/or dinner (use of 70/30 insulin
should be avoided unless patient is unable to comply with mixed regimen). If frequent hypoglycemia occurs >4 hours after dinner, fast-
acting insulin could be given alone at dinner and NPH moved to bedtime.
NOTE: Consider Glargine (Lantus) instead of NPH if: 1) hypoglycemia occurs due to NPH/fast-acting insulin overlap despite dosage-time
adjustments, OR 2) patient unable to comply with multiple injections per day. Refer to basal/bolus insulin algorithm on page 4.
This medication chart is designed to assist clinicians in diabetes management. It is not intended to replace a clinician’s judgment or establish a protocol for all patients.
For national recommendations, references and additional copies of the guideline, go to or call (303) 446-7200. This medication chart was supported with funds from The Colorado Health Foundation.
Developed February 2012.
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