From the Guidelines
The recommended starting dose of NPH insulin for a 68kg individual is 0.1-0.2 units per kilogram per day, which would be approximately 6.8-13.6 units daily, and can also be started with a fixed dose of 10 units per day, as suggested by the most recent guidelines 1.
Calculation of NPH Dose
To calculate the dose, we can use the weight-based approach: 0.1-0.2 units/kg/day. For a 68kg individual, this would be:
- 0.1 units/kg/day: 0.1 x 68 = 6.8 units/day
- 0.2 units/kg/day: 0.2 x 68 = 13.6 units/day Given these calculations, a reasonable starting point could be around 10 units per day, as it falls within the suggested range and is a straightforward dose to manage.
Administration Frequency
NPH insulin is typically administered in a twice-daily regimen. The total daily dose can be split, with two-thirds given before breakfast and one-third before dinner, or in an equal split between morning and evening doses. For example, if starting with 10 units total daily, this could be divided as 6-7 units in the morning and 3-4 units in the evening.
Considerations for Dose Adjustment
It's crucial to monitor blood glucose levels closely when initiating NPH insulin and adjust the dose based on the patterns observed. The guidelines suggest increasing the dose by 2 units every 3 days to reach the fasting plasma glucose (FPG) goal without causing hypoglycemia 1. If hypoglycemia occurs, the dose should be lowered by 10-20%. Regular assessment of the adequacy of the insulin dose and consideration of clinical signals for overbasalization are also important.
Importance of Individualization
Insulin requirements can vary significantly between individuals due to factors such as insulin sensitivity, diet, activity level, and other medications. Therefore, the initial dose and subsequent adjustments should be tailored to the individual's response, emphasizing the importance of blood glucose monitoring and potentially adjusting the dose every 2-3 days based on the observed patterns.
From the FDA Drug Label
In some patients with type 2 diabetes, more LEVEMIR may be required than NPH insulin. In a clinical study, the mean dose at end of treatment was 0.77 U/kg for LEVEMIR and 0. 52 IU/kg for NPH human insulin
The recommended starting dose of NPH insulin for a 68kg individual can be estimated based on the mean dose of NPH human insulin, which is 0.52 IU/kg.
- Calculated dose: 0.52 IU/kg * 68 kg = 35.36 IU, round to 35 IU The frequency of administration is not directly stated for NPH insulin in the provided drug label, but it can be administered once- or twice-daily, similar to LEVEMIR. However, the exact frequency for NPH insulin cannot be determined from the provided information 2.
From the Research
NPH Insulin Dosing for a 68kg Individual
To determine the recommended starting dose and frequency of NPH insulin for a 68kg individual, we can look at the provided evidence.
- The starting dose of NPH insulin is typically around 0.1-0.2 units/kg/day 3.
- For a 68kg individual, the starting dose would be approximately 6.8-13.6 units/day.
- Another study suggests initiating NPH insulin at a dose of 10 units/day 4.
- The dose can be titrated based on the patient's self-measured fasting plasma glucose levels, with a goal of achieving a fasting plasma glucose of 4.0-5.5 mmol/l 5.
- The insulin dose can be increased by 1-2 units per day until the desired fasting glucose level is reached 3, 4.
Frequency of NPH Insulin Administration
- NPH insulin is typically administered once or twice daily, with the evening dose being more common 5, 4.
- The frequency of administration may depend on the individual patient's needs and response to the insulin therapy.
- It is essential to monitor the patient's blood glucose levels and adjust the insulin dose and frequency as needed to achieve optimal glycemic control 3, 6.
Important Considerations
- The patient's weight, glucose levels, and other factors should be taken into account when determining the starting dose and frequency of NPH insulin 3, 4.
- Regular monitoring of blood glucose levels and adjustment of the insulin dose and frequency are crucial to achieve optimal glycemic control and minimize the risk of hypoglycemia 5, 6.
- The patient should be educated on how to self-adjust their insulin dose and use a modem to send the results of home glucose monitoring to treatment centers 5.