From the Guidelines
For patients requiring insulin, a reasonable starting point for basal insulin is 5 units of NPH/detemir insulin subcutaneously every 12 h or 10 units of insulin glargine every 24 h, as stated in the standards of medical care in diabetes-2020 1. When determining the subcutaneous insulin dose, several factors must be considered, including the patient's previous insulin dosing, type of diabetes, and current nutritional intake.
- For patients with type 1 diabetes, it is crucial to continue basal insulin even if feedings are discontinued, with a reasonable estimate of basal needs made from the preadmission dose of long-acting or intermediate insulin or a percentage of the total daily requirements established in the hospital (usually 30–50% of the total daily dose of insulin) 1.
- In the absence of previous insulin dosing, the starting point can be adjusted based on the patient's nutritional intake, such as 1 unit of insulin for every 10–15 g carbohydrate per day for those receiving continuous tube feedings 1.
- Correctional insulin should also be administered subcutaneously every 6 h using human regular insulin or every 4 h using a rapid-acting insulin, such as lispro, aspart, or glulisine, to address any blood glucose imbalances 1. The insulin regimen should include coverage of basal, prandial, and correctional needs to achieve optimal blood glucose control and minimize the risk of hypoglycemia and other complications.
- Regular blood glucose monitoring and close medical supervision are essential for adjusting insulin dosing and ensuring the patient's safety and well-being 1.
From the FDA Drug Label
The maximum glucose-lowering effect of insulin aspart occurred between 1 and 3 hours after subcutaneous injection (0. 15 units/kg). The duration of action for insulin aspart is 3 to 5 hours.
The subcutaneous dose of insulin aspart is 0.15 units/kg, with a duration of action of 3 to 5 hours and a maximum glucose-lowering effect between 1 and 3 hours after injection 2.
- Key points:
- Dose: 0.15 units/kg
- Duration of action: 3 to 5 hours
- Maximum glucose-lowering effect: 1 to 3 hours after injection
- Important consideration: The time course of action of insulin and insulin analogs such as insulin aspart products may vary considerably in different individuals or within the same individual 2.
From the Research
Insulin Subcutaneous Dose
- The optimal insulin subcutaneous dose is not explicitly stated in the provided studies, but they discuss various aspects of insulin therapy, including the use of insulin analogues and their effects on glycemic control and hypoglycemia risk 3, 4, 5, 6, 7.
- A study comparing exenatide with mealtime insulin lispro in patients with type 2 diabetes found that exenatide resulted in similar glycemic control with fewer nonnocturnal hypoglycemic episodes, but more gastrointestinal adverse events 3.
- Another study discussed the pharmacokinetic and pharmacodynamic profiles of basal insulins, including insulin degludec, which has a flat and stable glucose-lowering profile and a duration of action exceeding 30 hours 4.
- The development of insulin analogues has made it possible to reproduce more accurately the physiologic insulin profiles seen in people without diabetes, with rapid-acting analogues offering improved postprandial glycemic control and reduced risk of hypoglycemia, and long-acting analogues mimicking the insulin secretory profile of basal insulin 5, 6.
- However, changes in the structure of the insulin molecule may alter its metabolic and mitogenic activity, raising concerns about the safety of insulin analogues, such as the potential relationship between insulin lispro and insulin glargine and the progression of diabetic retinopathy 7.
Key Findings
- Insulin degludec has a flat and stable glucose-lowering profile and a duration of action exceeding 30 hours 4.
- Exenatide resulted in similar glycemic control with fewer nonnocturnal hypoglycemic episodes, but more gastrointestinal adverse events compared to mealtime insulin lispro 3.
- Insulin analogues can reproduce more accurately the physiologic insulin profiles seen in people without diabetes, offering improved glycemic control and reduced risk of hypoglycemia 5, 6.
Insulin Analogues
- Rapid-acting analogues, such as insulin aspart and insulin lispro, offer improved postprandial glycemic control and reduced risk of hypoglycemia 5, 6.
- Long-acting analogues, such as insulin glargine and insulin detemir, mimic the insulin secretory profile of basal insulin 5, 6.
- Insulin degludec is an ultra-long-acting insulin analogue with a flat and stable glucose-lowering profile and a duration of action exceeding 30 hours 4.