From the Guidelines
NPH insulin should be started at 10 units per day or 0.1-0.2 units/kg per day, with a goal of achieving target fasting plasma glucose (FPG) levels, and titrated based on individual needs, as recommended by the most recent guidelines 1. When initiating NPH insulin, it's essential to set a FPG goal and choose an evidence-based titration algorithm, such as increasing the dose by 2 units every 3 days to reach the FPG goal without causing hypoglycemia 1. Key considerations for NPH insulin dosing include:
- Starting dose: 10 units per day or 0.1-0.2 units/kg per day
- Titration algorithm: increase by 2 units every 3 days to reach FPG goal
- Hypoglycemia management: lower dose by 10-20% if no clear cause is found Regular insulin dosing should be individualized, considering factors such as meal timing and carbohydrate intake. Some general principles for Regular insulin dosing include:
- Administering Regular insulin 30 minutes before meals
- Starting with a dose of 0.1-0.2 units/kg before breakfast and dinner
- Adjusting the dose based on blood glucose monitoring results, with pre-meal targets of 80-130 mg/dL and post-meal targets below 180 mg/dL 1. It's crucial to assess the adequacy of insulin dose at every visit and consider clinical signals to evaluate for overbasalization and the need for adjunctive therapies, such as GLP-1 RAs or dual GIP and GLP-1 RAs, if A1C remains above goal 1.
From the Research
Dosing of N and R Insulin
- The dosing of N (NPH) and R (regular) insulin can be initiated with a premixed 70/30 insulin administered twice daily, as studied in patients with type 2 diabetes 2.
- For insulin initiation, a starting dose of 10 units or 0.2 units/kg can be used, with an increase of 2 units every 3 days until fasting levels are consistently in the target range 3.
- The use of premix insulin analogs, such as 70/30 insulin, has been shown to improve postprandial glycemic control and health-related quality of life without increasing the frequency of hypoglycemic events 2.
- When using NPH insulin, it can be administered twice daily, with a potential reduction in hypoglycemic events compared to premixed insulin analogs 4.
- Regular insulin can be administered before each meal, with intermediate insulin administered at bedtime, to maintain blood glucose levels within a target range 5.
Titration and Adjustment
- Insulin doses can be adjusted based on fasting blood glucose levels, with a reduction of 4 units if hypoglycemia occurs 3.
- The titration of insulin doses should be individualized to each patient, taking into account their specific needs and response to therapy 6.
- The use of self-monitoring of blood glucose levels can help guide insulin dose adjustments and improve glycemic control 5.