From the FDA Drug Label
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.
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 in patients with Diabetes Mellitus (DM) is:
- Type 1 Diabetes: approximately one-third of the total daily insulin requirements, with short-acting insulin used to satisfy the remainder of the daily insulin requirements.
- Type 2 Diabetes: 0.2 units/kg or up to 10 units once daily. Dosage adjustments should be made under medical supervision with appropriate glucose monitoring 1.
From the Research
Introduction to Insulin Dosage in Diabetes Mellitus (DM)
Insulin therapy is a crucial component in the management of Diabetes Mellitus (DM), particularly for patients with type 1 diabetes and those with type 2 diabetes who require insulin due to inadequate glycemic control with other therapies. The appropriate insulin dosage is vital to achieve optimal glycemic control, minimize the risk of hypoglycemia, and prevent long-term complications associated with diabetes.
Initiating Basal Insulin Therapy
When initiating basal insulin therapy, as discussed in 2, it is recommended to start with a conservative dose. This approach helps in gradually adjusting the patient's body to the insulin and reduces the risk of hypoglycemia. The initial dose of basal insulin is typically around 10 units/day or 0.1-0.2 units/kg/day.
Titration of Basal Insulin
The dosage of basal insulin needs to be titrated based on the patient's self-measured fasting plasma glucose levels to achieve an individualized target, usually between 80-130 mg/dL, as mentioned in 2. This titration process should be gradual, with dose adjustments made every few days to weeks, depending on the patient's response and the specific insulin formulation being used.
Dose Adjustment and Titration Guidelines
- Initial Dose Adjustment: Start with a low dose and gradually increase it.
- Titration: Increase the dose by 1 unit per day (for NPH, insulin detemir, and glargine 100 units/mL) or 2-4 units once or twice per week (for NPH, insulin detemir, glargine 100 and 300 units/mL, and degludec) until the fasting plasma glucose levels are consistently within the target range.
- Maximum Dose: The dose of basal insulin can be increased up to approximately 0.5-1.0 units/kg/day in some cases, as indicated in 2.
Considerations for Insulin Therapy
- Overbasalization: Avoid continuing to escalate the dose without a meaningful reduction in fasting plasma glucose, as this can lead to unnecessary hypoglycemia and other complications.
- Switching Between Basal Insulins: This can be done using simple regimens, but pharmacokinetic and pharmacodynamic differences between formulations require explicit guidance to patients, as noted in 2.
- Use of Continuous Glucose Monitoring (CGM): CGM can be beneficial in managing type 1 diabetes, even for those using insulin injections, as it helps in achieving better glycemic control, as shown in 3.
- Combination Therapy: Adding glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide to basal insulin can significantly improve glycemic control and reduce body weight in patients with uncontrolled type 2 diabetes, as demonstrated in 4.
Conclusion
The appropriate insulin dosage in patients with Diabetes Mellitus (DM) depends on several factors, including the type of diabetes, the patient's current glycemic control, and the specific insulin formulation being used. Healthcare providers should follow guidelines for initiating and titrating basal insulin, consider the use of CGM and combination therapies, and always prioritize patient education and safety to achieve optimal diabetes management.