How do you determine the units of Novolin (Human Insulin) needed?

Determining Units of Novolin (Human Insulin) Needed

For patients requiring insulin therapy, the initial dose of Novolin should be 10 units per day or 0.1-0.2 units/kg per day, with subsequent titration by increasing 2 units every 3 days until reaching target fasting plasma glucose without hypoglycemia. 1, 2

Initial Dosing Algorithm

Basal Insulin Initiation

• Start with 10 units per day OR 0.1-0.2 units/kg per day 1, 2, 3
• Set fasting plasma glucose (FPG) target goals
• For type 1 diabetes: typical total daily dose is 0.5 units/kg/day (50% basal, 50% prandial) 2
• For type 2 diabetes: dosing depends on degree of insulin resistance and hyperglycemia 2

Titration Process

• Increase dose by 2 units every 3 days to reach FPG goal without hypoglycemia 1
• For hypoglycemia: determine cause; if no clear reason, reduce dose by 10-20% 1
• Assess adequacy of insulin dose at every visit 1

Intensification When A1C Remains Above Target

Adding Prandial Insulin

• Start with one dose with the largest meal or meal with greatest postprandial glucose excursion 1
• Initial prandial dose: 4 units per day or 10% of basal insulin dose 1
• Titration: Increase dose by 1-2 units or 10-15% twice weekly 1
• For hypoglycemia: determine cause; if no clear reason, lower corresponding dose by 10-20% 1

For NPH Insulin (Novolin N)

If using bedtime NPH and converting to twice-daily regimen:

• Total dose = 80% of current bedtime NPH dose
• 2/3 given before breakfast, 1/3 given at bedtime 1
• Titrate based on individualized needs

Advanced Insulin Regimens

Full Basal-Bolus Regimen

• Add prandial insulin with each meal
• Add 4 units of short/rapid-acting insulin to each injection or 10% of reduced NPH dose 1
• Titrate each component based on individualized needs

For Premixed Insulin (Novolin 70/30)

• Contains 70% NPH and 30% Regular insulin
• Can be used to replace self-mixed insulin regimens, often on a dose-for-dose basis 4
• Administer twice daily: 2/3 before breakfast, 1/3 before dinner 1

Calculating Insulin for Carbohydrate Coverage

For patients using carbohydrate counting:

• Dose = (Carbohydrates ÷ Carbohydrate ratio) + (Current glucose - Target glucose) ÷ Insulin sensitivity factor 2
• Carbohydrate ratio typically starts at 1 unit per 10-15g of carbohydrates 2
• Insulin sensitivity factor can be estimated by dividing 1800 by the total daily dose of insulin 2

Common Pitfalls and Caveats

• Overbasalization: Avoid continuing to escalate basal dose without meaningful reduction in FPG; consider adding prandial insulin or other agents when basal dose exceeds 0.5 units/kg/day 3
• Insulin concentration errors: Ensure correct insulin concentration (U-100 most common) when calculating doses 2
• Hypoglycemia risk: Monitor blood glucose regularly, especially when initiating or adjusting insulin doses 1
• Insulin stacking: Consider insulin still active from previous doses to avoid hypoglycemia 2
• Special situations: Adjust insulin doses during acute illness, surgery, corticosteroid therapy, or changes in nutrition 2

By following this structured approach to determining Novolin dosing, clinicians can effectively initiate and adjust insulin therapy to achieve optimal glycemic control while minimizing the risk of hypoglycemia.