From the Guidelines
Regular insulin dosing should be initiated at 10 units per day or 0.1-0.2 units/kg per day, with titration based on an evidence-based algorithm, such as increasing the dose by 2 units every 3 days to reach the target fasting plasma glucose (FPG) goal without hypoglycemia. The dosing scale for regular insulin, such as Novolin R or Humulin R, is not directly provided in the given evidence, but the initiation and titration guidelines for basal analog or bedtime NPH insulin can be applied, as stated in the 2025 standards of care in diabetes 1.
Key Considerations
- The initial dose can be set based on the patient's weight, with 0.1-0.2 units/kg per day being a common starting point.
- The FPG goal should be set according to the individual's needs and clinical guidelines.
- An evidence-based titration algorithm should be chosen to adjust the insulin dose, aiming to reach the FPG goal without causing hypoglycemia.
- If hypoglycemia occurs, the dose should be lowered by 10-20% to prevent further episodes.
Monitoring and Adjustment
- The adequacy of the insulin dose should be assessed at every visit, considering clinical signals for overbasalization and the need for adjunctive therapies.
- The patient's A1C levels should be monitored, and if above goal, consideration should be given to adding other therapies, such as GLP-1 RA or dual GIP and GLP-1 RA, in combination with insulin 1.
Administration and Storage
- Regular insulin should be administered subcutaneously, typically 30 minutes before meals, and injection sites should be rotated to prevent lipohypertrophy.
- The insulin should be stored properly, refrigerated until opened, and then at room temperature for up to 28 days.
Individualization
- Individualization of the insulin dose is crucial, as insulin sensitivity varies widely between patients based on factors such as weight, insulin resistance, concurrent illness, and other medications.
- Blood glucose levels should be monitored regularly to assess the response to the insulin dose and make adjustments as needed.
From the Research
Dosing Scale for Regular Insulin
The dosing scale for regular insulin, such as Novolin R or Humulin R, is not explicitly stated in the provided studies. However, the following general guidelines for insulin dosing can be found:
- Basal insulin is usually initiated at a conservative dose of 10 units/day or 0.1-0.2 units/kg/day, then titrated thereafter over several weeks or months, based on patients' self-measured fasting plasma glucose, to achieve an individualized target (usually 80-130 mg/dL) 2.
- The dose of basal insulin should be increased as required up to approximately 0.5-1.0 units/kg/day in some cases 2.
- For patients with type 2 diabetes, insulin regimens should be adjusted every three or four days until targets of self-monitored blood glucose levels are reached, with a fasting and premeal blood glucose goal of 80 to 130 mg per dL and a two-hour postprandial goal of less than 180 mg per dL 3.
- Regular insulin can be used as a short-acting insulin, and the dosing scale may vary depending on the patient's individual needs and response to the medication.
Key Considerations
When determining the dosing scale for regular insulin, the following factors should be considered:
- The patient's individual needs and response to the medication
- The type and severity of diabetes
- The presence of any comorbid conditions
- The risk of hypoglycemia and other potential side effects
- The patient's lifestyle and ability to self-manage their diabetes
Insulin Regimens
The following insulin regimens may be used in combination with regular insulin:
- Basal insulin: usually initiated at a conservative dose of 10 units/day or 0.1-0.2 units/kg/day, then titrated thereafter over several weeks or months 2
- Premixed insulin: may be used in combination with basal insulin or as a separate injection 4, 5
- Rapid-acting insulin: may be added to the treatment plan to control postprandial glucose levels 5