From the Research
For a 70 kg patient requiring regular insulin, I recommend starting with a weight-based dosing approach of 0.5-0.6 units/kg/day, which equals approximately 35-42 units of total daily insulin, as this approach has been shown to be effective in managing blood glucose levels 1.
Key Considerations
- The total daily insulin dose should be divided with about 50% as basal insulin (such as NPH, glargine, or detemir) and 50% as mealtime regular insulin split between three meals.
- Regular insulin should be administered 30 minutes before meals due to its delayed onset of action.
- Blood glucose monitoring is essential, with checks before meals and at bedtime.
- The insulin doses should be adjusted based on blood glucose patterns, with increases or decreases of 10-20% every 2-3 days until target glucose levels are achieved.
Adjusting Insulin Doses
- For correction doses, a common starting point is 1 unit of regular insulin to lower blood glucose by 50 mg/dL (2.8 mmol/L) 2.
- It is also important to consider the risk of hypoglycemia, particularly when using basal insulin analogs such as glargine or detemir, and to adjust the doses accordingly 3, 4.
Choosing the Right Insulin
- The choice of basal insulin analog (e.g. glargine, detemir, or degludec) should be based on individual patient needs and characteristics, such as the risk of hypoglycemia and the presence of renal or hepatic impairment 5, 1.
- Insulin degludec has been shown to be associated with less frequent and milder hypoglycemia in insulin-deficient patients with type 1 diabetes compared with insulin glargine or detemir 4.