In the March 2020 issue of Clinical Diabetes, our Practical Pointers article (1) outlined a definition for overbasalization as the titration of basal insulin beyond an appropriate dose in an attempt to achieve glycemic targets. Although there is consensus in this general definition, it does not offer clinicians a practicable marker to identify overbasalization. Indeed, the only clear-cut case of overbasalization would be an increase in the basal insulin dose of a patient with controlled fasting plasma glucose (FPG) to treat postprandial hyperglycemia. As we expect such an event to be uncommon, why, then, is overbasalization a growing concern?

The primary role of basal insulin in type 2 diabetes is to control fasting hyperglycemia by replacing a patient’s insulin production lost secondary to diminished β-cell function (2). The amount of insulin required to achieve this “replacement” is affected by insulin resistance; a higher insulin dose...

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