What is the appropriate insulin dosing for inpatients (inpatient) with diabetes?

From the Guidelines

Inpatient insulin dosing should start with a total daily dose of 0.1-0.2 units/kg per day or 10 units per day, with a basal-bolus regimen and correction doses, as recommended by the most recent guidelines 1. When initiating insulin therapy in the hospital, it's essential to consider the patient's individual needs and clinical status.

• The American Diabetes Association recommends starting with a total daily dose of 0.1-0.2 units/kg per day or 10 units per day 1.
• The basal-bolus regimen is preferred, with 50% of the total daily dose allocated to basal insulin and 50% to bolus insulin, divided into three meals 1.
• Correction doses should be used to address hyperglycemia, with a typical dose of 1 unit of rapid-acting insulin for every 50 mg/dL above the target glucose level 1.
• It's crucial to monitor glucose levels regularly, adjusting the insulin dose every 1-2 days as needed, and to avoid using sliding scale insulin as the sole regimen, as it can lead to hypoglycemia and is not preventative 1.
• For patients with poor oral intake or those who are restricted from oral intake, a basal plus bolus correction regimen is recommended 1.
• The use of premixed insulin formulations is not routinely recommended for in-hospital use due to the increased risk of hypoglycemia 1.

From the FDA Drug Label

1. 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. Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), during acute illness, or changes in renal or hepatic function. Dosage adjustments should only be made under medical supervision with appropriate glucose monitoring [see Warnings and Precautions (5.2)]. In patients with type 1 diabetes, Insulin Glargine must be used concomitantly with short-acting insulin.

The insulin dosing for inpatients is to be individualized and adjusted based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goal.

• Administer Insulin Glargine subcutaneously once daily at any time of day but at the same time every day.
• Dosage adjustments may be needed with changes in physical activity, changes in meal patterns, during acute illness, or changes in renal or hepatic function.
• Dosage adjustments should only be made under medical supervision with appropriate glucose monitoring 2.
• In patients with type 1 diabetes, Insulin Glargine must be used concomitantly with short-acting insulin.

From the Research

Insulin Dosing in Patients

• Insulin dosing is crucial for managing diabetes, and various insulin analogues are available for clinical use 3, 4.
• Rapid-acting analogues, such as insulin aspart and insulin lispro, provide better postprandial glucose control and less hypoglycaemia than regular insulin 3.
• Basal analogues, such as insulin glargine and insulin detemir, mimic the insulin secretory profile of basal insulin and offer improved fasting glucose control and reduced risk of hypoglycaemia 3, 4.

Insulin Regimens

• People with type 1 diabetes require a multiple injection regimen or pumped insulin, often moderated by continuous glucose monitoring (CGM) 5.
• For type 2 diabetes, the starting regimen is normally basal only, usually with insulin glargine, and a meal-time insulin analogue is added when required 5.
• Hypoglycaemia is a significant issue in type 1 diabetes, but can be managed with CGM, pumps, and careful dose adjustment 5, 6.

Insulin Administration

• Alternative routes of insulin administration, such as pulmonary insulin, have been studied, but inhaled insulin is similar to regular insulin in terms of efficacy and safety 3.
• Continuous subcutaneous insulin infusion (CSII) therapy is also used, and the choice of rapid-acting insulin analogue can affect pump compatibility and stability 6.
• Cross-reactivity of insulin analogues with insulin assays can vary, and some analogues may show significant interference in certain assays 7.