What is the appropriate insulin dosage?

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Last updated: March 28, 2025 • View editorial policy

From the Guidelines

Insulin dosage should be individualized based on a person's specific needs, blood glucose levels, and medical history, with a typical starting regimen for type 2 diabetes including basal insulin at 10 units daily or 0.1-0.2 units per kg of body weight, as recommended by the 2017 American Diabetes Association standards of medical care in diabetes 1.

Key Considerations

  • For type 2 diabetes, starting doses are often lower, with basal insulin beginning at 10 units daily or 0.1-0.2 units per kg of body weight, and adjustments should be made in small increments (1-2 units) every 2-3 days based on blood glucose readings 1.
  • 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% 1.
  • Providers should consider decreasing the basal insulin dose by the same amount of the starting mealtime dose, and cost considerations are important when an insulin product is selected, particularly because of substantial price increases over the past decade 1.

Insulin Therapy

  • Comprehensive education about blood glucose monitoring, nutrition, and hypoglycemia recognition and treatment are critical to patients receiving insulin therapy, and empowering patients with self-titration algorithms based on self-monitoring can improve glucose control in those with type 2 diabetes initiating insulin therapy 1.
  • Regular monitoring is essential, with target fasting glucose of 80-130 mg/dL and post-meal levels below 180 mg/dL, and hypoglycemia symptoms (shakiness, confusion, sweating) require immediate treatment with 15 grams of fast-acting carbohydrates.

Concentrated Insulin Products

  • Several concentrated insulin preparations are available, including U-500 formulation of regular insulin, which is 5 times as concentrated as the U-100 formulation, and has a delayed onset and longer duration of action than the latter, with both prandial and basal properties 1.

From the FDA Drug Label

2 DOSAGE AND ADMINISTRATION

2.2 General Dosing Instructions Administer Insulin Glargine subcutaneously once daily at any time of day but at the same time every day. Individualize and adjust the dosage of Insulin Glargine based on the patient's metabolic needs, blood glucose monitoring results and glycemic control goal. 2.3 Initiation of Insulin Glargine Therapy Recommended Starting Dosage in Patients with Type 1 Diabetes The recommended starting dosage of Insulin Glargine in patients with type 1 diabetes is approximately one-third of the total daily insulin requirements. Recommended Starting Dosage in Patients with Type 2 Diabetes The recommended starting dosage of Insulin Glargine in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg or up to 10 units once daily.

The appropriate insulin dosage is:

  • For patients with Type 1 Diabetes: approximately one-third of the total daily insulin requirements.
  • For patients with Type 2 Diabetes who are not currently treated with insulin: 0.2 units/kg or up to 10 units once daily. Dosage adjustments should be made under medical supervision with appropriate glucose monitoring 2.

From the Research

Insulin Dosage

  • The appropriate insulin dosage can be determined based on the patient's weight and type of diabetes, with a starting dose of 0.3 units per kg for augmentation therapy or 0.6 to 1.0 units per kg for replacement therapy 3.
  • For replacement therapy, 50% of the total daily insulin dose is given as basal, and 50% as bolus, divided up before breakfast, lunch, and dinner 3.
  • The insulin dose may need to be adjusted over time to achieve optimal glycemic control and prevent diabetes-related complications 3, 4.

Factors Affecting Insulin Dosage

  • The choice of insulin therapy should consider factors such as glucose control, adverse effects, cost, adherence, and quality of life 3.
  • The type of insulin used, such as premixed, bolus, or basal insulin, can affect the dosage and frequency of administration 3, 4.
  • Patient characteristics, such as age, weight, and presence of other health conditions, may also influence the insulin dosage 4, 5.

Comparison of Insulin Types

  • Long-acting insulin preparations have been shown to have a beneficial effect on nocturnal glucose levels and may be associated with a lower risk of hypoglycemia compared to intermediate-acting insulins 6.
  • Premixed insulin has been associated with greater weight gain and higher dose requirements compared to other types of insulin 4.
  • Rapid-acting insulin analogues, such as insulin aspart, may be suitable for use in continuous subcutaneous insulin infusion (CSII) therapy and may offer improved glycemic control and reduced risk of hypoglycemia compared to other insulins 7.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.