Endocrinology Book

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Insulin Dosing in Type 1 DiabetesAka: Insulin Dosing in Type I Diabetes

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  1. See Also
    1. Carbohydrate Counting
    2. Insulin Dosing
    3. See Insulin Dosing in Type II Diabetes
    4. Insulin Adjustment with Carbohydrate Counting
  2. Initial Dosing with basal/bolus Insulin
    1. Calculate total Insulin dose
      1. Ketones moderate or less: 0.5 units/kg/day
      2. Ketones large: 0.7 units/kg/day
    2. Divide total Insulin into basal and bolus dosing
      1. Basal Insulin (long-acting): 50% of total Insulin
        1. Insulin Glargine (Lantus) once daily (any time) or
        2. NPH Insulin twice daily
      2. Bolus Insulin (rapid acting): 50% of total Insulin
        1. Rapid acting Insulins: Lispro, Aspart
          1. Regular Insulin may be used instead due to cost
        2. Divide out equally before meals
        3. Adjust later for carb count variations at meals
    3. Example: 60 kg adult with moderate ketones
      1. Total Insulin dose: 30 units
      2. Divide Insulin
        1. Insulin Glargine (Lantus): 15 units at bedtime
        2. Insulin Lispro: 15 units total divided over meals
          1. Before breakfast: 5 units
          2. Before lunch: 5 units
          3. Before dinner: 5 units
  3. Conversion from mixed Insulin (70/30 or 75/25)
    1. Calculate total Insulin units
    2. Reduce total Insulin depending of Hemoglobin A1C
      1. Hemoglobin A1C >9%: Decrease total Insulin by 10%
      2. Hemoglobin A1C <9%: Decrease total Insulin by 20%
    3. Divide total Insulin into basal and bolus dosing
      1. Basal Insulin (long-acting): 50% of total Insulin
        1. Insulin Glargine (Lantus) once daily or
        2. NPH Insulin twice daily
      2. Bolus Insulin (rapid acting): 50% of total Insulin
        1. Rapid acting Insulins: Lispro, Aspart
        2. Divide out equally before meals
        3. Adjust later for carb count variations at meals
  4. Management: Adjustments
    1. See Insulin Dosing for adjustment regimen

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