From the Guidelines
For a 75kg insulin-naive patient, initiation of insulin therapy typically commences with a basal insulin regimen, such as glargine (Lantus) or detemir (Levemir), at a dose of 0.1-0.2 units/kg/day 1. This translates to a starting dose of 7.5-15 units of glargine or detemir, administered once daily, with subsequent titration based on fasting glucose levels.
Key Considerations
- The initial dose can be estimated based on body weight and the degree of hyperglycemia 1.
- Basal insulin is usually prescribed in conjunction with metformin and sometimes one additional noninsulin agent 1.
- The cost of insulin is an important consideration, and human insulin (NPH and regular) may be a more affordable option for some patients 1.
- Clinicians should be aware of the potential for overbasalization with insulin therapy and adjust the dose accordingly 1.
Insulin Regimens
- Basal insulin: glargine (Lantus) or detemir (Levemir) at a dose of 0.1-0.2 units/kg/day, administered once daily 1.
- Premixed insulin: aspart mix 70/30 (NovoLog Mix 70/30) at a dose of 0.2-0.4 units/kg/day, divided into two daily injections 1.
- The choice of insulin regimen should be individualized based on the patient's needs and preferences 1.
From the FDA Drug Label
- 3 Initiation of Insulin Glargine-yfgn Therapy Recommended Starting Dosage in Patients with Type 2 Diabetes The recommended starting dosage of Insulin Glargine-yfgn 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.
For a 75kg insulin naive patient, the initial insulin dose is 0.2 units/kg or up to 10 units once daily.
- The dose would be: 75 kg * 0.2 units/kg = 15 units once daily.
- However, the maximum initial dose is 10 units once daily. Therefore, the initial insulin dose for a 75kg insulin naive patient is 10 units once daily 2.
From the Research
Initial Insulin Dose for a 75kg Insulin Naive Patient
- The initial insulin dose for a 75kg insulin naive patient is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, study 3 mentions that the mean insulin dose at the end of therapy was 0.353 +/- 0.256 IU/kg for intensive mixture therapy (IMT) and 0.276 +/- 0.207 IU/kg for once-daily insulin glargine.
- Using this information, we can estimate the initial insulin dose for a 75kg patient.
- For IMT, the estimated initial insulin dose would be around 0.353 IU/kg * 75 kg = 26.48 IU, but this is the dose at the end of therapy, not the initial dose.
- For once-daily insulin glargine, the estimated initial insulin dose would be around 0.276 IU/kg * 75 kg = 20.7 IU, but again, this is the dose at the end of therapy, not the initial dose.
- Study 5 provides information on the titration algorithm used to adjust insulin dosage, but does not provide a specific initial dose.
- Studies 4, 6, and 7 do not provide information on the initial insulin dose for a 75kg insulin naive patient.
- Therefore, based on the provided studies, there is no clear answer to the question of what the initial insulin dose should be for a 75kg insulin naive patient.