4.5.3.0 Pran­di­al In­sulin

In­di­vid­u­als with type 2 di­a­betes may re­quire doses of in­sulin be­fore meals in ad­di­tion to basal in­sulin. The rec­om­mend­ed start­ing dose of meal­time in­sulin is ei­ther 4 units or 10% of the basal dose at each meal. Titra­tion is done based on home glu­cose mon­i­tor­ing or A1C. With significant ad­di­tions to the pran­di­al in­sulin dose, par­tic­u­lar­ly with the evening meal, con­sid­er­a­tion should be given to de­creas­ing the basal in­sulin dose. Meta-‍anal­y­ses of tri­als com­par­ing rapid-‍act­ing in­sulin ana­logs with human reg­u­lar in­sulin in pa­tients with type 2 di­a­betes have not re­port­ed im­por­tant dif­fer­ences in A1C or hy­po­glycemia (78,79).