From the Guidelines
The recommended insulin dose for hyperglycemia is typically initiated at 0.2-0.3 units/kg per day, with subcutaneous administration being the standard route. This dose can be adjusted based on the patient's response to therapy, with the goal of achieving target glucose levels. According to the most recent evidence 1, for non-critically ill patients with diabetes, basal insulin with or without correction doses may be used for moderate hyperglycemia, with a starting dose of 0.2-0.3 units/kg per day.
Key Considerations
- The route of administration is typically subcutaneous, using insulin pens or syringes.
- Insulin requirements vary significantly between individuals based on insulin sensitivity, body weight, concurrent illness, and other medications.
- Regular blood glucose monitoring is essential to adjust insulin doses appropriately and prevent hypoglycemia.
- The choice of insulin type and dose should be individualized based on the patient's specific needs and clinical situation.
Insulin Therapy
Insulin therapy works by facilitating glucose uptake into cells, suppressing hepatic glucose production, and inhibiting lipolysis, thereby lowering blood glucose levels. The most recent evidence 1 suggests that basal-bolus insulin therapy is often used for outpatient management, with a total daily dose starting at 0.3-0.5 units/kg/day, divided into basal insulin and bolus insulin.
Clinical Guidelines
Clinical guidelines recommend that insulin therapy should not be delayed in patients not achieving glycemic goals 1. The American Diabetes Association recommends that insulin should be used with any combination regimen in newly diagnosed patients when severe hyperglycemia causes ketosis or unintentional weight loss 1. The most recent evidence 1 provides guidance on insulin dosing for enteral/parenteral feedings, with recommendations for basal and correctional insulin doses.
From the FDA Drug Label
Individualize dosage based on metabolic needs, blood glucose monitoring, glycemic control, type of diabetes, and prior insulin use. Administer subcutaneously into the abdominal area, thigh, or deltoid once daily at any time of day, but at the same time every day.
The recommended insulin dose should be individualized based on the patient's metabolic needs and other factors. The insulin is administered subcutaneously into the abdominal area, thigh, or deltoid once daily at the same time every day 2.
From the Research
Recommended Insulin Dose
- The recommended starting dose of insulin is 0.1-0.2 units/kg/day 3 or 10 units/day 3.
- For patients with type 2 diabetes, insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg 4.
- The dose of basal insulin should be increased as required up to approximately 0.5-1.0 units/kg/day in some cases 3.
Route of Administration
- Insulin is administered subcutaneously 5, 6, 4, 7.
- The basal-bolus approach uses subcutaneous insulin, with 0.5 U/kg basal insulin (glargine once daily, or neutral protamine Hagedorn [NPH] twice daily) and 0.1 U/kg rapid analog at each meal (lispro, aspart, or glulisine) for the average patient 6.
Titration of Insulin
- The dose of insulin should be titrated based on patients' self-measured fasting plasma glucose, to achieve an individualized target (usually 80-130 mg/dL) 3.
- Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications 4.
- A simple rule is to gradually increase the initial dose by 1 unit per day (NPH, insulin detemir, and glargine 100 units/mL) or 2-4 units once or twice per week (NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until FPG levels remain consistently within the target range 3.