What is the weight-based management for an 80 kg female regarding Basal (long-acting) insulin and bolus (short-acting, 'bonus') insulin?

From the Guidelines

For an 80 kg female patient, I recommend starting with 0.1 to 0.2 units/kg of body weight of basal insulin per day, which equals 8-16 units daily, and adjusting the dose by 10% to 15% once or twice weekly until the fasting blood glucose target is met, as well as starting mealtime insulin at 0.1 U/kg per meal or 4 U per meal, as suggested by the American Diabetes Association standards of medical care in diabetes 1.

Basal Insulin Dosing

• The recommended starting dose of basal insulin is 0.1 to 0.2 units/kg of body weight per day, which for an 80 kg patient would be 8-16 units daily.
• The dose should be increased by 10% to 15%, or 2 to 4 units, once or twice weekly until the fasting blood glucose target is met.
• Basal insulin is typically used with metformin and sometimes 1 additional noninsulin agent.

Bolus Insulin Dosing

• The recommended starting dose of mealtime insulin is 4 U per meal, 0.1 U/kg per meal, or 10% of the basal insulin dose per meal if the HbA1c level is less than 8%.
• Providers should consider decreasing the basal insulin dose by the same amount of the starting mealtime dose.
• Rapid-acting insulin analogues are preferred because of their quick onset of action.

Monitoring and Adjustments

• Regular monitoring is essential, checking blood glucose at least 4 times daily initially.
• Insulin requirements should be adjusted based on blood glucose monitoring, with target fasting glucose of 80-130 mg/dL and postprandial glucose below 180 mg/dL.
• Insulin sensitivity varies between individuals, so dose adjustments should be made every 2-3 days based on glucose patterns.

From the FDA Drug Label

For patients with type 1 or type 2 diabetes on basal-bolus treatment, changing the basal insulin to LEVEMIR can be done on a unit-to-unit basis. In some patients with type 2 diabetes, more LEVEMIR may be required than NPH insulin. In a clinical study, the mean dose at end of treatment was 0.77 U/kg for LEVEMIR and 0.52 IU/kg for NPH human insulin 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.

For an 80 kg female, the basal insulin dose can be estimated as follows:

• The dose for LEVEMIR can be around 0.77 U/kg as seen in the clinical study, which would be approximately 61.6 U (0.77 U/kg x 80 kg) for LEVEMIR.
• The dose for NPH human insulin can be around 0.52 IU/kg, which would be approximately 41.6 U (0.52 U/kg x 80 kg) for NPH human insulin.

Regarding bolus insulin, the provided information does not directly address the weight-based management for an 80 kg female. The daily bolus insulin dose in the studies ranged from 0.38 to 0.52 U/kg. For an 80 kg female, this would translate to a daily bolus insulin dose of approximately 30.4 to 41.6 U (0.38 to 0.52 U/kg x 80 kg). However, the exact dose should be individualized and adjusted to achieve glycemic targets 2.

From the Research

Basal Insulin Management

• The initiation dose of basal insulin is usually 10 units/day or 0.1-0.2 units/kg/day 3
• For an 80 kg female, the initial dose would be 8-16 units/day (0.1-0.2 units/kg/day)
• The dose of basal insulin should be increased as required up to approximately 0.5-1.0 units/kg/day in some cases 3

Bolus Insulin Management

• Adding fast-acting insulin aspart to basal insulin significantly improved glycaemic control in patients with type 2 diabetes 4
• The use of a basal-bolus regimen with fast-acting insulin aspart resulted in a greater reduction in HbA1c levels compared to basal-only insulin 4
• However, the basal-bolus regimen was associated with an increased frequency of hypoglycaemia and modest weight gain 4

Weight-Based Management

• The total daily insulin dose for a basal-bolus regimen can be up to 1.2 U/kg, with a weight gain of 1.8 kg 4
• For an 80 kg female, the total daily insulin dose would be up to 96 units/day (1.2 U/kg)
• However, the optimal dose and weight-based management strategy may vary depending on individual patient factors and response to treatment 3, 4