What is the moderate dose range for insulin therapy in patients with type 2 diabetes?

From the Guidelines

The moderate dose range for insulin therapy in patients with type 2 diabetes is typically between 0.1 to 1.0 units per kilogram of body weight per day, with a common starting dose of 10 units or 0.1-0.2 units/kg/day of basal insulin per day. This approach is based on the most recent and highest quality study available, which emphasizes the importance of individualizing insulin therapy and considering factors such as cost, patient education, and self-monitoring of blood glucose 1.

Key Considerations for Insulin Therapy

• Insulin therapy often begins at a lower dose and is gradually titrated upward based on blood glucose monitoring results.
• The total daily dose is commonly split between basal insulin and bolus insulin if using a multiple daily injection approach.
• Patients typically need more insulin in the morning due to dawn phenomenon, so the distribution might not be equal throughout the day.
• Insulin requirements often increase with longer duration of diabetes, higher body weight, insulin resistance, and concurrent illnesses or medications like corticosteroids.

Initiating Insulin Therapy

• A safe and simple approach is to prescribe 10 units, or 0.1 to 0.2 units/kg of body weight, of basal insulin per day and advise to increase the dose by 10% to 15%, or 2 to 4 units, once or twice weekly until the fasting blood glucose target is met 1.
• Insulin is typically used with metformin and sometimes 1 additional noninsulin agent.
• Cost considerations are important when an insulin product is selected, particularly because of substantial price increases over the past decade.

Advancing Insulin Therapy

• Advancing insulin therapy for patients not achieving HbA1c goals on optimally titrated basal insulin alone often requires premeal insulin dosing.
• The rapid-acting insulin analogues are preferred because of their quick onset of action.
• The recommended starting dose of mealtime insulin is 4 U per meal, 0.1 U/kg per meal, or 10% of the basal insulin dose per meal if the HbA1c level is less than 8% 1.

From the FDA Drug Label

2.3 Initiation of Insulin Glargine-yfgn Therapy Recommended Starting Dosage in Patients with Type 2 Diabetes The recommended starting dosage of Insulin Glargine-yfgn in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg or up to 10 units once daily.

The moderate dose range for insulin therapy in patients with type 2 diabetes is not explicitly defined in the provided drug label. However, the label recommends a starting dosage of 0.2 units/kg or up to 10 units once daily for patients with type 2 diabetes who are not currently treated with insulin 2.

• The label does not provide a specific moderate dose range, but rather a starting dosage.
• Dosage adjustments should be made under medical supervision with appropriate glucose monitoring.
• The dosage may need to be adjusted based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goal.

From the Research

Moderate Dose Insulin Scale

The moderate dose range for insulin therapy in patients with type 2 diabetes can be determined based on several factors, including the patient's weight, fasting plasma glucose levels, and individualized treatment goals.

• The initial dose of basal insulin is usually recommended to be 10 units/day or 0.1-0.2 units/kg/day, and then titrated thereafter based on the patient's self-measured fasting plasma glucose levels 3.
• The dose of basal insulin can be increased as required up to approximately 0.5-1.0 units/kg/day in some cases, but overbasalization should be avoided 3.
• A simple rule for titrating the dose is to gradually increase the initial dose 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 fasting plasma glucose levels remain consistently within the target range 3.
• The mean dose of insulin glargine at randomization in one study was 61 units/day, indicating that moderate doses of insulin can vary depending on the patient's needs and response to treatment 4.

Factors Influencing Insulin Dosing

Several factors can influence the dosing of insulin in patients with type 2 diabetes, including:

• The patient's weight and body mass index (BMI) 3
• Fasting plasma glucose levels and individualized treatment goals 3
• The type and formulation of insulin used (e.g. basal insulin, bolus insulin, or fixed-ratio combinations) 3, 4, 5
• The presence of comorbidities or other health conditions that may affect insulin sensitivity or glucose metabolism 6, 7
• The patient's lifestyle and self-care habits, including diet, physical activity, and glucose self-monitoring 7

Individualized Treatment Goals

Individualized treatment goals are essential for determining the moderate dose range for insulin therapy in patients with type 2 diabetes.

• The goal of treatment is to achieve and maintain optimal glycemic control, while minimizing the risk of hypoglycemia and other adverse effects 3, 4, 5.
• The target range for fasting plasma glucose levels is usually between 80-130 mg/dL, but this can vary depending on the patient's individual needs and circumstances 3.
• Other factors, such as weight, blood pressure, and lipid profiles, should also be considered when determining individualized treatment goals 6, 7.