What are the basal insulin dosing guidelines for a 70-kilogram patient with diabetes?

From the Guidelines

For a 70 kg patient requiring basal insulin, I recommend starting with 0.1-0.2 units/kg per day, which equals 7-14 units daily, as suggested by the most recent guidelines 1. This approach is based on the latest standards of care in diabetes, which emphasize the importance of individualized treatment and careful titration to achieve optimal glycemic control.

Key Considerations

• The initial dose can be adjusted based on the patient's response and the presence of hypoglycemia, with a goal of achieving a fasting plasma glucose (FPG) level within the target range.
• The choice of basal insulin analog, such as insulin glargine or insulin degludec, should be based on the patient's specific needs and medical history.
• Regular monitoring of blood glucose levels and adjustment of the insulin dose as needed are crucial to maintaining optimal glycemic control and minimizing the risk of hypoglycemia.

Titration and Monitoring

• The dose of basal insulin should be titrated based on the patient's FPG levels, with a goal of achieving a level within the target range, as recommended by the guidelines 1.
• The patient should be instructed to monitor their blood glucose levels regularly and to report any episodes of hypoglycemia, which may require a dose reduction.
• The healthcare provider should assess the adequacy of the insulin dose at every visit and consider clinical signals to evaluate for overbasalization and the need for adjunctive therapies, as suggested by the guidelines 1.

From the FDA Drug Label

Daily Basal Insulin Dose (U/kg) Prestudy mean 0.36 End of study mean 0.49 Daily Basal Insulin Dose (U/kg) Prestudy mean 0.48 End of study mean 0.67

For a patient weighing 70 kg, the basal insulin dose can be calculated as follows:

• Using the prestudy mean dose of 0.36 U/kg, the total daily basal insulin dose would be 0.36 U/kg * 70 kg = 25.2 U.
• Using the end of study mean dose of 0.49 U/kg, the total daily basal insulin dose would be 0.49 U/kg * 70 kg = 34.3 U.
• Using the prestudy mean dose of 0.48 U/kg, the total daily basal insulin dose would be 0.48 U/kg * 70 kg = 33.6 U.
• Using the end of study mean dose of 0.67 U/kg, the total daily basal insulin dose would be 0.67 U/kg * 70 kg = 46.9 U. It is essential to note that these calculations are based on the provided data and may not be directly applicable to the specific patient. The actual basal insulin dose should be determined by a healthcare professional, taking into account the patient's individual needs and medical history 2.

From the Research

Basal Insulin Doses

• The initial dose of basal insulin is usually 10 units/day or 0.1-0.2 units/kg/day 3
• For a patient weighing 70 kg, the initial dose would be 7-14 units/day (0.1-0.2 units/kg/day x 70 kg)
• The dose can be titrated based on the patient's self-measured fasting plasma glucose to achieve an individualized target (usually 80-130 mg/dL) 3

Titration of Basal Insulin

• The dose of basal insulin can be increased by 1 unit per day (for NPH, insulin detemir, and glargine 100 units/mL) or 2-4 units once or twice per week (for NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until the target fasting plasma glucose is achieved 3
• The maximum dose of basal insulin can be up to 0.5-1.0 units/kg/day in some cases 3

Comparison of Basal Insulins

• Insulin detemir and insulin glargine have similar efficacy and safety profiles in patients with type 2 diabetes 4, 5
• Insulin detemir may require higher doses and more frequent injections than insulin glargine to achieve the same level of glycemic control 6, 5
• There is no significant difference in the risk of hypoglycemia between insulin detemir and insulin glargine 4, 5