From the FDA Drug Label
The total daily insulin requirement may vary and is usually between 0.5 to 1 unit/kg/day.
The FDA drug label does not provide a maximum dose for insulin, but it does give a general guideline for the total daily insulin requirement, which is usually between 0.5 to 1 unit/kg/day 1.
From the Research
There is no absolute maximum dose for insulin as requirements vary widely among individuals. Insulin dosing is highly personalized and depends on factors such as body weight, insulin sensitivity, carbohydrate intake, physical activity level, stress, illness, and the presence of insulin resistance. For some patients with severe insulin resistance, doses may exceed several hundred units per day, while others might require only a few units. Insulin therapy typically starts at a low dose and is gradually titrated upward based on blood glucose monitoring results until target glucose levels are achieved. This careful adjustment helps minimize the risk of hypoglycemia, which is the primary concern with insulin therapy. Different insulin formulations (rapid-acting, short-acting, intermediate-acting, and long-acting) have different onset times, peak effects, and durations, which also influences dosing strategies. Regular monitoring of blood glucose levels is essential when using insulin to ensure appropriate dosing and to avoid dangerous low blood sugar episodes. Healthcare providers should regularly reassess insulin requirements as they may change over time due to weight changes, progression of diabetes, or development of other medical conditions. Some studies have compared the efficacy and safety of different insulin formulations, such as premixed insulin lispro and insulin glargine, in patients with type 2 diabetes mellitus 2. However, the most recent and highest quality study, published in 2022, compared the rapid-acting insulin analogue glulisine with lispro and aspart for the pump treatment of patients with type 1 diabetes, and found that glulisine had comparable glucose control to lispro/aspart 3. Key factors to consider when determining insulin dosing include:
- Body weight
- Insulin sensitivity
- Carbohydrate intake
- Physical activity level
- Stress
- Illness
- Presence of insulin resistance
- Type of insulin formulation used
- Onset time, peak effect, and duration of insulin action
- Blood glucose monitoring results
- Risk of hypoglycemia
- Weight changes
- Progression of diabetes
- Development of other medical conditions It is essential to note that insulin dosing should be individualized and adjusted based on regular monitoring of blood glucose levels and other factors that may affect insulin requirements. The goal of insulin therapy is to achieve target glucose levels while minimizing the risk of hypoglycemia and other adverse effects.