What is a typical normal insulin short-acting and long-acting (NPH) charting guide for diabetes management?

Normal Insulin Short and Long Acting Charting Guide

For optimal diabetes management, follow a structured insulin regimen with basal insulin in the morning and prandial insulin with meals, adjusting doses based on regular glucose monitoring to maintain target glucose levels of 90-150 mg/dL. 1

Basal (Long-Acting) Insulin Guidelines

Initiation and Titration

• Start with 10 units per day OR 0.1-0.2 units/kg per day 1
• For NPH insulin, consider morning administration rather than bedtime to better manage steroid-induced hyperglycemia and reduce nocturnal hypoglycemia 1, 2
• Titrate based on fasting glucose values:
  • If 50% of fasting glucose values are above goal (90-150 mg/dL): Increase by 2 units
  • If >2 fasting glucose values/week are <80 mg/dL: Decrease by 2 units 1

NPH Insulin Characteristics

• Duration of action: approximately 20 hours 3
• Peak effect: 4-6 hours after administration 4
• May require twice-daily dosing for optimal control in most patients 3

Prandial (Short-Acting) Insulin Guidelines

Regular Insulin

• Administer 30-45 minutes before meals 5
• Duration: 6-8 hours

Rapid-Acting Insulin Analogs

• Administer 0-15 minutes before meals 6
• Duration: 3-5 hours

Titration

• Start with 4 units per meal or 10% of basal insulin dose 1
• Increase by 1-2 units or 10-15% based on postprandial readings 1, 2
• Target pre-meal glucose: 90-150 mg/dL 1

Insulin Mixing Guidelines

Compatible Combinations

• Rapid-acting insulin can be mixed with NPH, lente, and ultralente 1
• When mixing rapid-acting with intermediate/long-acting insulin, inject within 15 minutes before a meal 1

Incompatible Combinations

• Do not mix insulin glargine with other forms of insulin due to its low pH 1
• Avoid mixing phosphate-buffered insulins (e.g., NPH) with lente insulins 1
• Do not use rapid-acting or short-acting insulin at bedtime 1

Premixed Insulin Options

Standard Premixed Ratios

• 70/30 (70% NPH, 30% regular)
• 75/25 (75% NPH, 25% rapid-acting)
• 50/50 (50% NPH, 50% regular) 1

Dosing

• For patients transitioning from basal-bolus to premixed insulin:
  • Use 70% of total daily dose as premixed insulin in the morning 1
  • 2/3 given before breakfast, 1/3 given before dinner 1

Simplified Sliding Scale (When Adjusting Prandial Insulin)

• Pre-meal glucose >250 mg/dL: Give 2 units of short/rapid-acting insulin
• Pre-meal glucose >350 mg/dL: Give 4 units of short/rapid-acting insulin
• Discontinue sliding scale when not needed daily 1

Special Considerations

Steroid-Induced Hyperglycemia

• NPH insulin is preferred when managing steroid-induced hyperglycemia 2
• Administer NPH insulin with morning steroid dose to synchronize peak insulin action with peak steroid effect 2
• Initial dosing: 0.1-0.2 units/kg/day 2
• For higher glucocorticoid doses, increase prandial and correction insulin by 40-60% 2

Perioperative Management

• Reduce basal insulin by 25% the evening before surgery to achieve better perioperative glucose control with lower hypoglycemia risk 1

Older Adults

• Consider simplifying insulin regimens in older adults:
  • Change timing of basal insulin from bedtime to morning
  • If using prandial insulin ≤10 units/dose: Consider discontinuing and adding non-insulin agents
  • If using prandial insulin >10 units/dose: Decrease dose by 50% and add non-insulin agent 1

Monitoring and Adjustment

• Monitor fasting glucose to titrate basal insulin
• Monitor both fasting and postprandial glucose to titrate mealtime insulin 6
• Adjust insulin doses every 2-3 days until target glucose levels are achieved 1
• For patients with high glucose variability, evaluate control using a combination of HbA1c and self-monitoring of blood glucose 6

By following this structured insulin charting guide, you can optimize diabetes management while minimizing the risk of hypoglycemia and hyperglycemia, ultimately improving patient outcomes related to morbidity, mortality, and quality of life.