Usual Adult Dose for Diabetes Type 1

Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin

Initial dose: One-third the total daily insulin requirement subcutaneously once a day or in divided doses twice a day

• Once daily dosing should be administered with the evening meal or at bedtime; twice daily dosing should be given morning and evening; the evening dose may be given with dinner, at bedtime, or 12 hours after the morning dose

Maintenance dose: Adjust according to metabolic needs, blood glucose measurements, and glycemic goals

Conversion from Other Insulin Therapies: Insulin glargine and NPH insulin can be converted on a unit to unit basis; closely monitor blood glucose during the transition and in the initial weeks thereafter, the dose and frequency of short-acting insulin may need to be adjusted.

Comments:

• The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.

Use: To improve glycemic control in patients with type 1 diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Dose should be individualized based on clinical response

• Insulin-naive: Initial dose: 10 units (or 0.1 to 0.2 units/kg) subcutaneously once a day or in divided doses twice a day
• For patients inadequately controlled on a GLP-1 receptor agonist: Initial dose: 10 units subcutaneously once a day
• Maintenance dose: Adjust according to metabolic needs, blood glucose measurements, and glycemic goals

Conversion from Other Insulin Therapies: Insulin glargine and NPH insulin can be converted on a unit to unit basis; however, some patients may require more insulin detemir than NPH insulin.

Comments:

• Once daily dosing should be administered with the evening meal or at bedtime; twice daily dosing should be given morning and evening; the evening dose may be given with dinner, at bedtime, or 12 hours after the morning dose.
• When changing treatment regimens, the dose and frequency of short-acting insulins and/or doses of any other anti-diabetic drugs may need to be adjusted.
• Closely monitor blood glucose during periods of transition and in the initial weeks thereafter.

Use: To improve glycemic control in patients with type 2 diabetes mellitus.

Usual Pediatric Dose for Diabetes Type 1

Age: 2 years or older:

• Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin

Initial dose: One-third the total daily insulin requirement subcutaneously once a day or in divided doses twice a day

• Once daily dosing should be administered with the evening meal or at bedtime; twice daily dosing should be given morning and evening; the evening dose may be given with dinner, at bedtime, or 12 hours after the morning dose

Maintenance dose: Adjust according to metabolic needs, blood glucose measurements, and glycemic goals

Conversion from Other Insulin Therapies: Insulin glargine and NPH insulin can be converted on a unit to unit basis; closely monitor blood glucose during the transition and in the initial weeks thereafter, the dose and frequency of short-acting insulin may need to be adjusted.

Comments:

• The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.

Use: To improve glycemic control in pediatric patients 2 years or older with type 1 diabetes mellitus.

Renal Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose adjustments may be required

Liver Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose adjustments may be required

Dose Adjustments

• Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery
• Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Dosage adjustments may be required when the brand, type, or species of insulin is changed; oral antidiabetic treatment may need to be adjusted as well.

Precautions

Safety and efficacy have not been established in patients younger than 2 years.
Safety and efficacy in patients with type 2 diabetes mellitus have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• Administer subcutaneously once or twice a day; do not give IM, IV or via an insulin pump
• Once daily administration should be with the evening meal or at bedtime; twice daily administration should be morning and evening, the evening dose may be given with dinner, at bedtime, or 12 hours after the morning dose
• Rotate injection sites within the same region (abdomen, thigh, or deltoid) to reduce the risk of lipodystrophy
• Never share an insulin pen between patients (even if the needle is changed) and do not reuse or share needles or syringes between patients when using vials as both present a risk for transmission of blood-borne pathogens.
• Do not dilute or mix with any other insulin or solution

Storage requirements:

• Unopened: Store in refrigerator 2C to 8C (36F to 46F), do not freeze, discard if frozen
• Opened (in-use): May keep unrefrigerated for up to 28 days after opening; keep away from direct heat and light; temperature should not exceed 30C (86F); discard 28 days after opening.

General:

• This drug is not recommended for the treatment of diabetic ketoacidosis; IV short-acting insulin is the preferred treatment for this condition.
• Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs.
• Hypoglycemia is the most common adverse reaction of insulin therapy; the timing generally reflects the time-action profile of the administered insulin.

Monitoring:

• Blood glucose monitoring is essential for all patients receiving insulin therapy, more frequent monitoring is recommended when insulin regimens are being adjusted.
• Monitor for signs and symptoms of heart failure in patients receiving concomitant thiazolidinediones.
• Urine ketone testing is recommended for patients with type I diabetes if they develop symptoms of colds, influenza, nausea, vomiting, or other illnesses, polyuria, or if blood glucose levels are unexpectedly high or inconsistent.
• Glycosylated hemoglobin measurements are recommended every 3 months.

Patient advice:

• Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
• Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
• Patients should be instructed on how to handle situations which may affect their insulin requirements.
• Remind patients to check insulin labels before injection to avoid medication errors.
• Patients should check blood sugar prior to driving a car or operating machinery.
• Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.

Frequently asked questions

• How and where should I inject insulin?