Insulin Dosing in Type 1 Diabetes

Aka: Insulin Dosing in Type 1 Diabetes, Insulin Dosing in Type I Diabetes

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II. Dose: Initial Dosing with basal/Bolus Insulin

  1. Calculate total daily Insulin (TDI) 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. InsulinLispro: 15 units total divided over meals
        1. Before breakfast: 5 units
        2. Before lunch: 5 units
        3. Before dinner: 5 units

III. Dose: 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

IV. Management: Adjustments

  1. See Insulin Dosing for adjustment regimen

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