insulin, premix insulin, basal plus. Most of the international standard guidelines recommend initiation of basal insulin once and further titration according to the sugars. But, as you know that the Indian diet is a carbohydrate rich diet, a twice-daily premix regime is more preferred by the diabetologists while initiating the insulin regime, at the cost of more frequency of hypoglycemia. This is also one of the reasons for uncontrolled glycemia despite insulin therapy.

SMBG and total diet recall from the patient are required for further titration of insulin. Diet counseling plays an important role in patients with postprandial hyperglycemia.

If there is persistent postprandial hyperglycemia, then a premeal short-acting bolus insulin can be added. This is known as “basal plus” regime. This regime has lesser hypos and the titration is easier in comparison to the premix regime. There is flexibility for the patients to take the insulin with the largest meal of the day. This also empowers the patients to titrate their own insulin by a few units on their own using SMBG.