Is 10 Units of Insulin Appropriate?
Yes, 10 units is an appropriate starting dose for basal insulin in insulin-naive patients with type 2 diabetes, and it is also a reasonable starting dose for hospitalized patients without prior insulin use. 1, 2
Context-Specific Guidance
For Outpatient Insulin Initiation (Type 2 Diabetes)
- Starting dose: 10 units once daily OR 0.1-0.2 units/kg body weight is the standard recommendation for insulin-naive patients 1, 2
- Administration timing: Give at the same time each day, typically with evening meal or at bedtime 1
- Continue metformin unless contraindicated when starting basal insulin 1
For Hospitalized Patients
- 10 units of basal insulin glargine every 24 hours is explicitly recommended as a reasonable starting point for patients without previous insulin dosing 1
- Alternative: 5 units of NPH/detemir insulin subcutaneously every 12 hours 1
- For patients on enteral/parenteral feeding, 10 units of insulin glargine every 24 hours is appropriate 1, 2
For Correction Doses
- 10 units is NOT appropriate as a single correction dose for most patients 3, 4
- Correction insulin should be 2-4 units for mild hyperglycemia (>250 mg/dL) 3, 4
- For blood glucose 300 mg/dL, start with 4 units of rapid-acting insulin 3
- The insulin sensitivity factor (1500÷total daily dose) determines appropriate correction doses, not arbitrary amounts 3
Titration After Starting 10 Units
Aggressive titration is essential to avoid prolonged hyperglycemia 1, 2:
- Increase by 2 units every 3 days if fasting glucose 140-179 mg/dL 1, 2
- Increase by 4 units every 3 days if fasting glucose ≥180 mg/dL 1, 2
- Target fasting glucose: 80-130 mg/dL 1, 2
Critical Threshold: When 10 Units Is Insufficient
When basal insulin exceeds 0.5 units/kg/day (typically 35-50 units for average adults), adding prandial insulin becomes more appropriate than continuing to escalate basal insulin alone 1, 3, 2. This prevents "overbasalization" which causes hypoglycemia without improving control 1, 3.
Common Pitfalls to Avoid
- Never use 10 units as sliding scale monotherapy - this approach is explicitly condemned by all guidelines and leads to poor outcomes 1, 4, 5
- Don't delay titration - waiting longer than 3 days between adjustments unnecessarily prolongs hyperglycemia 1, 2
- Don't stop metformin when starting insulin unless contraindicated - the combination reduces insulin requirements and weight gain 1, 5
- Don't continue escalating beyond 0.5-1.0 units/kg/day without adding prandial coverage 1, 3, 2
Special Populations Requiring Dose Adjustment
Lower doses (0.1-0.25 units/kg/day, approximately 5-10 units) are appropriate for 1, 2: