This commentary will discuss the issue of overbasalization. To focus the discussion clinically, let us consider two similar patients whose glycemia has not been well managed on noninsulin drugs and who are both started on basal insulin but have different responses.

This is an obese man who has had diabetes for 15 years, with a BMI of 36 kg/m2. His diabetes has not been controlled with maximal doses of metformin, a dipeptidyl dipeptidase 4 (DPP-4) inhibitor, and pioglitazone, and his A1C is 9.2%. He is kept on these oral agents, and a basal insulin is initiated and titrated upward. Six months later, the majority of his fasting plasma glucose (FPG) readings are in the range of 140–180 mg/dL, and he is taking 0.7 units/kg of basal insulin. His before-dinner glucose readings range from 160 to 220 mg/dL, and his A1C is 8.1%. Preprandial bolus doses of insulin are...

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