What dose of insulin is appropriate for treating hyperglycemia?

From the Guidelines

Insulin Dosing for Hyperglycemia

The appropriate dose of insulin for treating hyperglycemia is 4 units per day or 10% of basal 1.

Initiation and Adjustment of Insulin Therapy

• Insulin therapy should be initiated for the treatment of persistent hyperglycemia $180 mg/dL (10.0 mmol/L) 1, 1.
• The target glucose range for the majority of critically ill patients is 140–180 mg/dL (7.8–10.0 mmol/L) 1, 1.
• For noncritically ill patients, a target range of 100–180 mg/dL (5.6–10.0 mmol/L) is recommended 1.
• Insulin dosing should be based on basal and correction components, taking into account the patient's body weight, expected sensitivity to insulin, and renal function 1.
• Clinical judgment and ongoing assessment of clinical status should guide day-to-day decisions regarding insulin dosing 1, 1.

Special Considerations

• In patients with renal insufficiency, lower insulin doses may be necessary 1.
• In terminally ill patients with short life expectancy, less aggressive insulin regimens may be appropriate to minimize glucosuria, dehydration, and electrolyte disturbances 1, 1.

From the FDA Drug Label

The dose of LEVEMIR should be adjusted according to blood glucose measurements. The dosage of LEVEMIR should be individualized based on the physician’s advice, in accordance with the needs of the patient. 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 appropriate dose of insulin for treating hyperglycemia is 0.1 to 0.2 U/kg once-daily in the evening or 10 units once- or twice-daily for insulin-naïve patients with type 2 diabetes, and should be adjusted according to blood glucose measurements and individualized based on the physician’s advice 2.

From the Research

Insulin Dosage for Hyperglycemia

The appropriate dose of insulin for treating hyperglycemia is not explicitly stated in the provided studies. However, the following points can be considered:

• The optimal glucose range in the ICU population is still a matter of debate, but current recommendations include treating hyperglycemia after two consecutive glucose >180 mg/dL with target levels of 140-180 mg/dL for most patients 3.
• In critically ill patients, blood glucose levels >180 mg/dL may increase the risk of hospital complications, and blood glucose levels <110 mg/dL have been associated with an increased risk of hypoglycemia 4.
• A target glucose range of 110-180 mg/dL may be appropriate for most critically ill patients and noncritically ill patients 4.
• Continuous intravenous insulin infusion is the best method for achieving glycemic targets in the critically ill patient, while a basal-bolus insulin strategy resulted in better glycemic control than sliding scale insulin and lower risk of hypoglycemia than premixed insulin regimen in noncritically ill patients 4, 5.
• The preferred method of insulin initiation in type 2 diabetes mellitus is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with other oral antidiabetic drugs (OADs) 6.

Key Considerations

• The ideal glucose goals for noncritically ill patients remain undefined and must be individualized according to the characteristics of the patients 4.
• Hypoglycemia is a concern in insulin therapy, and the primary limiting factor for achieving optimal glycemic control with insulin therapy 7.
• Computer decision support systems can help reduce the risk of insulin infusion rate calculation errors and standardize insulin therapy 7.
• Communication with the primary care physician in the outpatient setting is an important part of discharge planning 7.

Insulin Therapy

• Insulin is the most appropriate pharmacologic agent for effectively controlling glycemia in hospital 4.
• A basal-bolus insulin strategy is preferred for noncritically ill patients, while continuous intravenous insulin infusion is the best method for achieving glycemic targets in the critically ill patient 4, 5.
• The pharmacodynamics of various insulin products should be considered when selecting an insulin regimen 7.