What is the insulin dosage scale?

From the Guidelines

Insulin scale dosing should be initiated with a dose of 4 units per day or 10% of the basal dose, with adjustments made based on individual patient needs and blood glucose readings, as recommended by the most recent guidelines 1. When determining the insulin scale dose, it's essential to consider the patient's individual insulin sensitivity, weight, and medical conditions.

• The initial dose can be adjusted by lowering the basal dose by 4 units per day or 10% of the basal dose, as needed.
• Rapid-acting insulins like Humalog (insulin lispro), NovoLog (insulin aspart), or Apidra (insulin glulisine) are typically used for scale dosing, administered before meals and at bedtime.
• Blood glucose should be checked 4-6 times daily, including before meals and at bedtime, to ensure that the insulin scale dose is effective in managing blood glucose levels. The American Diabetes Association recommends that insulin therapy be individualized, taking into account the patient's lifestyle, preferences, and medical history 1. It's crucial to understand that sliding scale insulin alone is not optimal for long-term diabetes management and should be combined with basal insulin or other diabetes medications.
• This approach works by providing supplemental insulin to address high blood glucose levels, with higher doses given for higher readings to bring glucose levels back to target range. Always consult with a healthcare provider before implementing or changing an insulin regimen, as individual needs vary significantly.

From the FDA Drug Label

CLINICAL STUDIES The efficacy and safety of LEVEMIR given once-daily at bedtime or twice-daily (before breakfast and at bedtime, before breakfast and with the evening meal, or at 12-hour intervals) was compared to that of once-daily or twice-daily NPH human insulin or once-daily insulin glargine in non-blinded, randomized, parallel studies of 6004 patients with diabetes (3724 with type 1, and 2280 with type 2).

Daily Basal Insulin Dose (U/kg) Prestudy mean 0.360.39 End of study mean0.490.45 Daily Bolus Insulin Dose (U/kg) Prestudy mean0.400.40 End of study mean0.380. 38 Daily Insulin Dose (U/kg) End of study mean0.770. 52

The insulin scale dosis is not explicitly stated in the provided text, but the daily basal insulin dose and daily bolus insulin dose are mentioned.

• The daily basal insulin dose ranged from 0.36 to 0.49 U/kg.
• The daily bolus insulin dose ranged from 0.38 to 0.40 U/kg.
• The daily insulin dose ranged from 0.52 to 0.77 U/kg. 2

From the Research

Insulin Scale Dosis

• The initial insulin dose for patients with type 2 diabetes mellitus can be started at 0.3 unit per kg as augmentation, or 0.6 to 1.0 unit per kg as replacement 3.
• When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner 3.
• The basal-plus strategy for insulin intensification involves adding one, two, or three prandial insulin injections to basal insulin according to individual need, allowing for individualization of treatment and potentially delaying progression to a full basal-bolus insulin replacement therapy 4.
• Insulin degludec is an ultra-long-acting insulin analogue with a flat and stable glucose-lowering profile, and a duration of action exceeding 30 hours, which can be used in a basal-bolus regimen with insulin aspart as the mealtime insulin 5.
• The choice of insulin therapy should consider factors such as glucose control, adverse effects, cost, adherence, and quality of life, and metformin should be continued if possible due to its proven benefits in reducing all-cause mortality and cardiovascular events in overweight patients with diabetes 3.

Key Considerations

• Hypoglycemia is a common adverse effect of insulin therapy, and the risk of hypoglycemia should be balanced with the benefits of improved glycemic control 3, 5, 6.
• Weight gain is also a potential adverse effect of insulin therapy, particularly with bolus insulin 3.
• The pharmacokinetic and pharmacodynamic profiles of different insulin analogues, such as insulin glargine and insulin detemir, can vary and should be considered when selecting an insulin regimen 5, 6, 7.