INSULIN DOSING













Basal insulins
Intermediate-acting insulins
  • Humulin® N (NPH)
  • Novolin® N (NPH)
Long-acting insulins
  • Basaglar® (insulin glargine)
  • Lantus® (insulin glargine)
  • Levemir® (insulin detemir)
  • Toujeo® (insulin glargine)
  • Tresiba® (insulin degludec)

Premeal insulins
Rapid-acting insulins
  • Admelog® (insulin lispro)
  • Afrezza® (inhaled insulin)
  • Apidra® (insulin glulisine)
  • Fiasp® (insulin aspart)
  • Humalog® (insulin lispro)
  • Novolog® (insulin aspart)
Short-acting insulins
  • Humulin® R (regular)
  • Novolin® R (regular)













Reference [12]
Fasting blood sugar (mg/dl)
average over 3 days
Adjustment to basal insulin dose
(units of insulin)
≥ 180 add 8 units
160 - 179 add 6 units
140 - 159 add 4 units
120 - 139 add 2 units
100 - 119 add 1 unit
80 - 99 no change
60 - 79 subtract 2 units
< 60 subtract 4 or more units



Reference [12]
  • If pre-lunch average is not in desired range, adjust pre-breakfast dose
  • If pre-dinner average is not in desired range, adjust pre-lunch dose
  • If pre-bedtime snack average is not in desired range, adjust pre-dinner dose
Premeal blood sugar (mg/dl)
average over 3 days
Adjustment to premeal insulin dose
≥ 180 add 3 units
160 - 179 add 2 units
140 - 159 add 2 units
120 - 139 add 1 units
100 - 119 maintain dose (desired range)
80 - 99 subtract 1 unit
60 - 79 subtract 2 units
< 60 subtract 4 or more units




  • If pre-lunch average is not in desired range (80 - 120 mg/dl), adjust breakfast ratio
  • If pre-dinner average is not in desired range (80 - 120 mg/dl), adjust lunch ratio
  • If pre-bedtime snack average is not in desired range (80 - 120 mg/dl), adjust dinner ratio
If average blood sugar is > 120 mg/dl, adjust ratio by subtracting 2 - 3g of carbohydrate
  • Example:
    • Current ratio 1 unit / 10g of carb
    • Pre-lunch average > 120 mg/dl
    • Change breakfast ratio to 1 unit / 7g of carb
If average blood sugar is < 80 mg/dl, adjust ratio by adding 2 - 3g of carbohydrate
  • Example:
    • Current ratio 1 unit / 10g of carb
    • Pre-bedtime snack average < 80 mg/dl
    • Change dinner ratio to 1 unit / 13g of carb
If average blood sugar is 80 - 120 mg/dl, do not adjust ratio








Step 1 - calculate the correction factor
  • For Regular insulin (Humulin R, Novolin R)
    • 1. Divide 1500 by the patient's total daily dose of insulin
    • 2. The result will equal the estimated drop in blood sugar (in mg/dl) from 1 unit of regular insulin
  • For Rapid insulin (Novolog, Humalog, Apidra, Fiasp, Admelog)
    • 1. Divide 1800 by the patient's total daily dose of insulin
    • 2. The result will equal the estimated drop in blood sugar (in mg/dl) from 1 unit of rapid insulin [4,12]
  • Example:
    • Patient's total daily dose of insulin (premeal + basal) is 60 units
    • Patient uses regular insulin as premeal insulin
    • 1500/60 = 25
    • Patient can expect that for every 1 unit of regular insulin they inject, their blood sugar will come down 25 mg/dl
Step 2 - Once the correction factor is calculated, the patient can then figure out how much insulin to supplement
  • Example:
    • Patient from above: correction factor is 25 mg/dl
    • Patient checks pre-lunch blood sugar and it is 175 mg/dl (desired range 80 - 120 mg/dl)
    • 175 - 120 = 55 mg/dl
    • 55/25 = approximately 2
    • Patient would add 2 extra units of regular insulin to premeal dose







Blood sugar (mg/dl) Insulin dose in
units of rapid or short-acting
< 150 0
150 - 200 2
201 - 250 4
251 - 300 6
301 - 350 8
351 - 400 10
401 - 450 12
> 450 14



Converting between insulin brands and types

Overview
  • It's important to note that patients may respond differently to different insulin brands and types
  • The conversion guidelines presented here are meant to serve as a starting point, but they will not necessarily achieve equivalent results across all patient populations
  • All patients should increase their blood sugar monitoring when switching insulins to determine the effects of the new regimen

Converting between rapid-acting and short-acting insulin
  • When converting between rapid-acting and short-acting insulins, the dose typically remains the same
  • Rapid-acting insulins act quicker (within 10 - 30 minutes) than short-acting insulins (within 30 - 60 minutes); therefore, the timing of the dose should be adjusted
  • Rapid-acting insulins have a shorter duration of action than short-acting insulins (3 - 5 hours vs 6 - 8 hours). This may mean patients switching to rapid-acting insulins from short-acting insulins may require more basal insulin to maintain blood sugar control, and vice versa.
  • Conversions for inhaled insulin are discussed here - inhaled insulin dosing

Converting between Lantus/Basaglar (Insulin glargine) and NPH
Once-a-day NPH to Lantus/Basaglar
  • Dose remains the same
Twice-a-day NPH to Lantus/Basaglar
  • Lantus/Basaglar dose is 80% of total daily NPH dose
  • Example:
    • Patient's NPH dose is 30 units twice-a-day
    • Total daily NPH dose is 60 units
    • To convert to Lantus/Basaglar: 60 units X 0.80 = 48 units
    • Daily Lantus/Basaglar dose will be 48 units [19]
Lantus/Basaglar to twice-a-day NPH
  • Lantus/Basaglar dose would be equivalent to about 80% of daily NPH dose
  • Example:
    • Patient's Lantus/Basaglar dose is 50 units a day
    • To convert to NPH: 50 units = (0.80)(Daily NPH dose); Daily NPH dose = 50/0.80 = 62.5 units
    • Daily NPH dose would be ∼ 62 units given in 2 divided doses
    • NOTE: Patients with hypoglycemia issues may want to leave the initial daily NPH dose the same as the Lantus/Basaglar dose

Converting between Lantus/Basaglar (Insulin glargine) and Levemir® (Insulin detemir)
  • Daily dose remains the same [20]

Converting between Lantus/Basaglar (Insulin glargine) and Toujeo® (Insulin glargine)
Lantus/Basaglar to Toujeo
  • When going from Lantus/Basaglar to Toujeo, the daily dose remains the same
  • Expect that a higher daily dose of Toujeo® will be needed to maintain the same level of glycemic control as an equivalent dose of Lantus/Basaglar
  • In a multidose study, the glucose-lowering effect of Toujeo® was about 27% lower than that of an equivalent dose of Lantus® [21]
Toujeo to Lantus/Basaglar
  • When going from Toujeo to Lantus/Basaglar, the Lantus/Basaglar dose should be started at 80% of the Toujeo dose in order to avoid hypoglycemia
  • Lantus/Basaglar is more potent than Toujeo, therefore, an equally effective Lantus/Basaglar dose will likely be lower [19,23]
  • Example:
    • Patient's Toujeo dose is 60 units a day
    • To convert to Lantus/Basaglar: 60 units X 0.80 = 48 units
    • Daily Lantus/Basaglar dose will be 48 units

Converting between Levemir® (Insulin detemir) and NPH
  • Daily dose remains the same [20]

Converting between Toujeo® (Insulin glargine) and twice-a-day NPH
  • Toujeo® dose is 80% of total daily NPH dose
  • Example:
    • Patient's NPH dose is 30 units twice-a-day
    • Total daily NPH dose is 60 units
    • To convert to Toujeo: 60 units X 0.80 = 48 units
    • Daily Toujeo dose will be 48 units [19]

Converting between Toujeo® (Insulin glargine) and Levemir® (Insulin detemir)
  • Daily dose remains the same [21]

Converting between Tresiba® (insulin degludec) and all other long- and intermediate-acting insulins
  • Daily dose remains the same
  • In trials comparing Tresiba to Lantus and Levemir, the glucose-lowering effect of Tresiba was equivalent to both insulins [22]