From the Guidelines
The starting dose of rapid-acting insulin should be 4 units per meal, as this is a safe and effective initial dose for most adults, according to the most recent guidelines 1. When determining the starting dose of rapid-acting insulin, it's essential to consider the patient's weight, insulin sensitivity, carbohydrate intake, and blood glucose levels.
- The dose may need to be adjusted based on individual factors, such as physical activity, illness, and stress.
- Patients should monitor their blood glucose levels before and after meals to assess the effectiveness of the dose.
- Rapid-acting insulin should be injected 15 minutes before meals to match the insulin action with food absorption.
- The main risk of insulin therapy is hypoglycemia, so patients should be educated about symptoms and treatment of low blood sugar.
- Regular follow-up with healthcare providers is essential to optimize the insulin regimen based on glucose patterns, as recommended by the 2023 standards of care in diabetes 1. The guidelines from 2023 provide the most up-to-date recommendations for initiating insulin therapy, and the starting dose of 4 units per meal is a straightforward and safe approach 1.
- This dose can be adjusted as needed based on the patient's response to therapy.
- It's crucial to individualize the dose based on the patient's specific needs and circumstances.
- By starting with a lower dose and gradually increasing as needed, patients can minimize the risk of hypoglycemia and other adverse effects.
- The 2023 guidelines emphasize the importance of regular monitoring and follow-up to ensure optimal glucose control and minimize complications 1.
From the Research
Rapid-Acting Insulin
The starting dose of rapid-acting insulin, such as Regular Insulin, is not explicitly stated in the provided studies. However, some general information about rapid-acting insulin can be found:
- Rapid-acting insulin analogues, such as insulin lispro and insulin aspart, have a faster onset of action and a shorter duration of activity compared to human regular insulin 2, 3, 4, 5.
- Insulin lispro begins to exert its effects within 15 minutes of subcutaneous administration, and peak levels occur 30 to 90 minutes after administration, with a duration of activity of less than five hours 5.
- The standard preparation of insulin aspart has the potential to better mimic the physiological response to meals than regular human insulin, and its efficacy is similar to that of insulin lispro when administered by continuous subcutaneous infusion 4.
Dosage Information
Some studies provide information on the dosage of rapid-acting insulin analogues:
- Insulin aspart administered immediately before meals resulted in significantly lower mean glycosylated haemoglobin A(1c) levels than regular human insulin (usually administered 30 minutes before a meal) 4.
- Biphasic insulin aspart [30% soluble (rapid-acting) and 70% protamine-bound insulin aspart (BIAsp30)] generally provided significantly better postprandial glucose control than a similar mixture of biphasic regular human insulin (BHI30) 4.
- Insulin glargine, a long-acting insulin, should be injected at a dose of 0.2 to 0.4 U/kg once or twice daily, but this is not a rapid-acting insulin 2.
Key Points
Key points to consider when using rapid-acting insulin:
- Rapid-acting insulin analogues offer faster subcutaneous absorption and an earlier and greater insulin peak compared to regular human insulin 3, 4, 5.
- The incidence of hypoglycaemia with rapid-acting insulin analogues is similar to or lower than that with human regular insulin 3, 4.
- Patients with type 1 or 2 diabetes reported greater treatment satisfaction with rapid-acting insulin analogues than with regular human insulin 3, 4.