Does the initial dosing of insulin (e.g. Actrapid (human insulin)) affect the starting dose?

From the Guidelines

The initial dosing of insulin, including Actrapid (human insulin), should be based on a conservative dose of 0.1 to 0.2 units/kg of body weight per day, with a safe and simple approach being to prescribe 10 units 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, as recommended by the 2017 American Diabetes Association standards of medical care in diabetes 1. When starting insulin therapy, clinicians typically begin with a conservative dose based on the patient's weight. For Actrapid specifically, which is a short-acting insulin, the timing of administration (usually 15-30 minutes before meals) is as important as the dose itself.

• The starting dose should be lower in elderly patients, those with renal or hepatic impairment, and patients at higher risk for hypoglycemia.
• Insulin requirements often increase with obesity, infection, stress, or steroid use.
• The initial dose is just a starting point, and frequent blood glucose monitoring is essential to adjust the dose appropriately.
• Titration typically occurs every 2-3 days until target blood glucose levels are achieved, as supported by the 2017 American Diabetes Association standards of medical care in diabetes 1. This cautious approach minimizes the risk of hypoglycemia while establishing effective glycemic control, as insulin sensitivity varies significantly between individuals.
• 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.
• Providers should consider decreasing the basal insulin dose by the same amount of the starting mealtime dose.
• Premixed insulin products containing both basal and bolus insulin are another option for patients who may benefit from simpler dosing, as noted in the 2017 American Diabetes Association standards of medical care in diabetes 1.

From the FDA Drug Label

For insulin-naïve patients with type 2 diabetes who are inadequately controlled on oral antidiabetic drugs, LEVEMIR should be started at a dose of 0.1 to 0. 2 U/kg once-daily in the evening or 10 units once- or twice-daily, and the dose adjusted to achieve glycemic targets.

The initial dosing of insulin, such as Actrapid (human insulin), may affect the starting dose. The dose should be individualized based on the physician’s advice, in accordance with the needs of the patient. For insulin-naïve patients, the starting dose can be 0.1 to 0.2 U/kg once-daily in the evening or 10 units once- or twice-daily 2.

From the Research

Initial Dosing of Insulin

The initial dosing of insulin, such as Actrapid (human insulin), can indeed affect the starting dose.

• The starting dose of insulin can vary depending on the type of insulin therapy, with augmentation therapy typically starting at 0.15 units per kg per day and replacement therapy starting at 0.5 units per kg per day 3.
• For patients with type 2 diabetes, the initial dose can be adjusted based on the patient's glucose levels, with the goal of achieving normal release patterns 3.
• In some cases, a lower initial dose may be effective, such as in the treatment of diabetic ketoacidosis, where low-dose intramuscular insulin therapy has been shown to be as effective as high-dose therapy without the risk of hypoglycemia 4.
• The use of insulin analogs, such as rapid-acting and long-acting analogs, can also affect the initial dosing, with these analogs offering improved physiologic profiles and reduced risk of hypoglycemia 5.
• In patients with type 1 diabetes using continuous subcutaneous insulin infusion, the initial dosing guidelines may need to be reassessed, with recent studies suggesting that current guidelines may be too high for basal insulin and too low for bolus insulin 6.
• For patients with prednisolone-induced hyperglycaemia, an initial daily insulin dose of 0.5 units/kg bodyweight or 130% of the current daily insulin dose may be recommended, with adjustments made as needed to achieve glycaemic control 7.