INSULIN DOSING SCHEDULES

The total daily dose of insulin is an estimation of the total daily insulin requirement in a non-pregnant
Type 1 diabetes patient, using a biosynthetic human insulin(s), or a purified animal-source (e.g.,
pork):

TOTAL DAILY DOSE = 0.5 Units x Ideal Body Weight (IBWt; in Kg)

IBWt (Males) = 50.0 Kg + 2.3 Kg/inch over 5 ft, or
IBWt (Females) = 45.5 Kg + 2.3 Kg/inch over 5 feet.


TIME ACTION CURVES OF INSULIN





















2
INJECTION SCHEDULES AND ASSESSMENT OF INSULIN PRARMACOTHERAPY

A. SINGLE DAILY DOSE USING INTERMEDIATE INSULIN (NPH or Lente)

Insulin distribution: 25 - 35% of total dose as short-acting (i.e., Regular) insulin, and
65 - 75% of total dose as intermediate-acting (i.e., NPH or Lente) insulin
Assessment of therapy: The action of the short-acting insulin is assessed by the glucose
measurement before lunch. The effect of the intermediate-acting insulin is reflected in the glucose
results before supper, at bedtime, and before breakfast the next day.

3
C. TWO DOSE, INTERMEDIATE-ACTING INSULIN REGIMEN (NPH or Lente)




4
Insulin Distribution:

2/3
rd
of the total dose is given in the morning in a ratio of 2:1 NPH (or Lente) to Regular.
1/3
rd
of the total dose is given in the evening in a ratio of 1:1 NPH (or Lente) to Regular

Assessment of therapy:

The morning short-acting insulin is assessed by the glucose result before lunch.
The morning intermediate-acting insulin is assessed by the glucose result before supper.
The evening short-acting insulin is assessed by the glucose result at bedtime.
The evening intermediate-acting insulin is assessed by the glucose result before breakfast the
next day.

E. THREE DOSE, SHORT/INTERMEDIATE-ACTING INSULIN REGIMEN: one injection of a
short-acting insulin (Regular) mixed with an intermediate-acting insulin (NPH or Lente) plus
one injection of a short-acting insulin plus one injection of an intermediate-acting insulin.



Insulin Distribution:
2/3
rd
of the total daily dose is given in the morning in a ratio of 2:1 NPH (or Lente) to Regular.
1/6
th
of the total daily dose is given in the evening (before supper) as Regular insulin.
1/6
th
of the total daily dose is given at bedtime as NPH (or Lente)

Assessment of therapy:
The morning short-acting insulin is assessed by the glucose result before lunch.
Morning intermediate-acting insulin is assessed by the glucose result before supper.
Evening short-acting insulin is assessed by the glucose result at bedtime.
Bedtime intermediate-acting insulin is assessed by the glucose result before breakfast the next
day.


F. THREE DOSE, ULTRALENTE/REGULAR (aka "Poor man's insulin pump") REGIMEN: one
injection of Regular insulin mixed with Ultralente, plus two injections of Regular insulin, each 30
minutes preprandially.


5

Insulin distribution:

50-60% of the total daily dose is given as Ultralente insulin to provide a "basal" level of insulin to cover
metabolic needs. The remaining dose is given as Regular insulin before meals (to cover the ingestion
of food) in a distribution ratio similar to the distribution ration of calories of the meals.

Assessment of therapy :

The morning dose of Regular insulin is assessed by the glucose result before lunch.
The lunchtime dose of Regular insulin is assessed by the glucose result before supper.
The evening dose of Regular insulin is assessed by the glucose result at bedtime.
The morning dose of Ultralente is assessed by the glucose result before breakfast the next day.

NOTE: The combination of insulin glargine (Lantus, Aventis) and either insulin lispro
(Humalog, Lilly) or insulin aspart (Novolog, Novo Nordisk) has been introduced as another
alternative. Administration of Lantus should be given SQ at HS (mimics basal insulin
secretion), with the rapid-acting insulin given after each meal (mimics a second-phase insulin
bolus), with dosing calculation determined by carbohydrate counting. As with any other
insulin, site rotation is still necessary. If a patient is switched from a QD regimen of NPH,
Lantus should be initiated at the same dosage and titrated appropriately. If converting from a
BID regimen of NPH, reduce the total daily dose by 20% (i.e., Lantus dose = 0.8 X NPH).
With no peak of action, the frequency of nocturnal hypoglycemia should be diminished (55%
of all severe hypoglycemia occurrences occur at night). Do NOT mix any other insulin in a
syringe with Lantus.