From the Research
When converting 75 units of NPH insulin to insulin glargine, the recommended starting dose would be approximately 70-75% of the NPH dose, which equals about 52-56 units of glargine. This reduction accounts for the different pharmacokinetic profiles between these insulins, as NPH has peaks and valleys in its action while glargine provides a more consistent, peak-free insulin level over 24 hours 1, 2, 3, 4. The conversion should be done cautiously with close blood glucose monitoring, as individual responses vary. Morning NPH doses should be converted to evening glargine, while twice-daily NPH regimens can be consolidated into a single glargine dose, typically given at bedtime. After starting glargine, dose adjustments should be made in 2-4 unit increments every 3-7 days based on fasting glucose readings.
Some key points to consider when making this conversion include:
- The importance of close monitoring of blood glucose levels to adjust the dose of glargine as needed 2
- The potential for a reduction in hypoglycemic events with glargine compared to NPH insulin 3, 4
- The need for consistent daily timing of glargine administration to achieve optimal effect 1
- The potential for improvements in glycemic control and reductions in weight gain and risk of hypoglycaemia with the use of glargine 5
It's also important to note that the specific dose conversion may vary depending on individual patient factors, such as the presence of renal or hepatic impairment, and the use of other medications that may interact with insulin. Therefore, the conversion should be done under the guidance of a healthcare professional, with careful monitoring and adjustment of the dose as needed.