From the Guidelines
20 units of insulin per day is generally considered a low to moderate dose, indicating potentially good control of Diabetes Mellitus, especially if the patient's weight is around 40-50 kg or more, as the recommended starting dose of basal insulin is 10 units per day or 0.1–0.2 units/kg/day 1, 2.
Key Considerations
- The dose of 20 units per day is below the threshold of 0.5 units/kg/day, which is considered a sign of overbasalization 3.
- The American Diabetes Association recommends a typical starting dose of 0.1-0.2 units/kg/day for basal insulin, and 20 units per day falls within this range for a patient weighing around 40-50 kg or more 1, 2.
- Total daily insulin requirements can be estimated based on weight, with typical doses ranging from 0.4 to 1.0 units/kg/day, and 20 units per day is within this range for some patients 4.
Important Factors
- Patient's weight: 20 units per day may be a low dose for a heavier patient, but a high dose for a lighter patient.
- Type of insulin: The type of insulin used, such as basal or prandial, can affect the dose required.
- Individualized needs: Insulin doses should be tailored to the individual patient's needs, taking into account factors such as diet, exercise, and glucose monitoring results 1, 2, 4.
From the Research
Insulin Dosage and Diabetes Control
- The dosage of 20 units of insulin per day does not directly indicate good or poor control of Diabetes Mellitus, as it depends on various factors such as the type of diabetes, patient's weight, diet, and physical activity level 5.
- A study found that patients with type 2 diabetes who required at least 20 units of insulin per day had a mean glucose level of 9.5 mmol/L on day 3, which is still higher than the recommended target 5.
- Another study found that high-dose insulin therapy is associated with an increased risk of cardiovascular disease, but this risk may be due to time-dependent confounding factors rather than the insulin dose itself 6.
Factors Affecting Insulin Dosage
- The dosage of insulin required by a patient can vary depending on their individual characteristics, such as age, weight, and diet 7.
- A study found that patients with type 2 diabetes who were recently diagnosed and had symptomatic severe hyperglycemia required higher doses of insulin initially, but were able to achieve good metabolic control with lower doses over time 7.
- The type of insulin used, such as short-acting or long-acting, can also affect the dosage required by a patient 8.
Risks Associated with High Insulin Dosage
- High insulin doses have been associated with an increased risk of cardiovascular disease, obesity, and decreased health span and life expectancy 9.
- However, a study found that the association between insulin dose and mortality may be confounded by time-dependent factors, and that insulin therapy may be safe for patients with type 2 diabetes when used appropriately 6.