Dosage forms, usual dosage regimen, and maximum recommended dosage of exogenous insulin products for adult patients, categorized by time of onset, peak, and duration of action, are summarized in Tables 2-7. Lyumjev and Lyumjev KwikPen (insulin lispro) is a rapid-acting insulin that was approved in June 2020 for subcutaneous use as an injection or with an insulin pump. It is also approved for intravenous use.19 Semglee (insulin glargine-yfgn) was approved by the FDA in July 2021, and it is the first FDA approved interchangeable biosimilar insulin product. Semglee is interchangeable with Lantus (insulin glargine).
Table 2. Adult Insulin Recommended Dosages for Single Insulin Products: Rapid-Acting11-18| Drug Name | Dosage Form | Labeled Dosage Regimen for Type 1 Diabetes * | Labeled Dosage Regimen for Type 2 Diabetes * |
|---|
| Insulin aspart | - Fiasp® vial (100 units/mL – 10 mL)
- Fiasp® FlexTouch (100 units/mL – 5 x 3 mL)
- Fiasp® PenFill® cartridges (100 units/mL – 5 x 3 mL) for FlexTouch® device
- NovoLog®, generic vial (100 units/mL – 10 mL)
- NovoLog® FlexPen®, generic FlexPen® (100 units/mL – 5 x 3 mL)
- NovoLog® PenFill®, generic cartridges (100 units/mL – 5 x 3 mL) for NovoPen Echo® device
| - 0.4-1.0 units/kg/day
- Generally, 50% of daily dosing is given as basal insulin, usually at night
- The other 50% is typically divided as prandial insulin
- Administer Fiasp® at start of meal or within 20 minutes after starting meal
- Administer NovoLog® and generics immediately before meals
| - 4 units or 10% of usual basal dose, given once daily before largest meal of the day, is recommended as initial dose
- If a1c less than 8% and patient is on basal insulin when insulin aspart is initiated, consider decreasing basal insulin by same amount as initiated insulin aspart
- Increase insulin aspart dose by 1-2 units, or 10-15%, twice weekly until blood glucose goals are met
- Administer Fiasp at start of meals or within 20 minutes of starting meal
- Administer NovoLog and generics immediately before meals
|
| Insulin glulisine | - Apidra® vial (100 units/mL – 10 mL)
- Apidra® SoloStar® pen (100 units/mL – 5 x 3 mL)
| - 0.4-1.0 units/kg/day
- Generally, 50% of daily dosing is given as basal insulin, usually at night
- The other 50% is typically divided as prandial insulin
- Administer insulin glulisine within 15 minutes before or 20 minutes after starting meal
| - 4 units or 10% of usual basal dose, given once daily before largest meal of the day, is recommended as initial dose
- If a1c less than 8% & patient is on basal insulin when insulin glulisine is initiated, consider decreasing basal insulin by same amount as initiated insulin aspart
- Increase insulin aspart dose by 1-2 units, or 10-15%, twice weekly until blood glucose goals are met
- If hypoglycemia occurs, determine cause, & decrease dose by 10-20%
|
| Insulin lispro | - Admelog® vial (100 units/mL – 3 or 10 mL)
- Admelog® SoloStar® pen (100 units/mL – 3 mL)
- HumaLog® cartridges (100 units/mL – 5 x 3 mL)
- HumaLog®, generic vial (100 units/mL – 3 or 10 mL)
- HumaLog® KwikPen®, generic (100 units/mL – 3 mL; 200 units/mL – 3 mL)
- Humalog Tempo (100 units/mL – 5 x 3 mL)
- Lyumjev® (100 units/mL – 10 mL)
- Lyumjev® KwikPen® (100 unit/ mL – 5 x 3 mL; 200 units/ mL – 2 x 3 mL)
| - 0.4-1.0 units /kg/day
- Generally, 50% of daily dosing is given as basal insulin, usually at night
- The other 50% is typically divided as prandial insulin
- Administer Humalog® or Admelog® 15 minutes prior to eating meal or immediately after a meal
- Administer Lyumjev® at the start of a meal or within 20 minutes after starting meal
| - 4 units or 10% of usual basal dose, given once daily before the largest meal of the day, is recommended as initial dose
- If a1c less than 8% & patient is on basal insulin when insulin lispro is initiated, consider decreasing basal insulin by same amount as initiated insulin lispro
- Increase insulin lispro dose by 1-2 units, or 10-15%, twice weekly until blood glucose levels are achieved
- If hypoglycemia occurs, determine cause, & decrease dose by 10-20%
- Administer Humalog® or Admelog® 15 minutes prior to eating meal or immediately after meal
- Administer Lyumjev® at start of meal or within 20 minutes after starting meal
|
Legend:
- Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; should be individualized for each patient
- No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
- Total daily doses of ALL insulin formulations combined is typically: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; non-obese patients may require less insulin than obese patients
- Non-obese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
Table 3. Adult Insulin Recommended Dosages for Insulin Combination Products: Short-Acting11,12, 19-22| Drug Name | Dosage Form | Labeled Dosage Regimen for Type 1 Diabetes * | Labeled Dosage Regimen for Type 2 Diabetes * |
|---|
| Inhaled insulin | - Afrezza® (4 units, 8 units, 12 units – single-use cartridges)
| - Insulin-naive patients: Start with 4 units at beginning of each meal
- Insulin-experienced patients: Determine appropriate dose of inhaled insulin for each meal using conversions provided by manufacturer
- Patients using pre-mixed insulin: Estimate mealtime dose by dividing half of total daily pre-mixed insulin dose equally among 3 daily meals. Convert to inhaled dose using manufacturer provided conversions
- Administer half of total daily injected pre-mixed dose as injected basal insulin dose
| - In insulin-naive patients, start with 4 units at beginning of each meal
- In patients using subcutaneous prandial insulin, determine appropriate dose of inhaled insulin for each meal using conversions provided by manufacturer
- In patients using subcutaneous pre-mixed insulin, estimate mealtime injected dose by dividing half of total daily pre-mixed insulin dose equally among 3 daily meals. Convert to inhaled dose using manufacturer provided conversions
- Administer half of total daily injected pre-mixed dose as injected basal insulin dose
- Consider subcutaneous insulin in patients requiring high doses of inhaled insulin without adequate blood sugar control
|
| Regular insulin | - Humulin® R vial (100 units/mL – 10 mL; 500 units/mL – 20 mL)
- Humulin® R KwikPen® (500 units/mL – 2 x 3 mL)
- Novolin® R vial (100 units/mL – 10 mL)
- Novolin® R FlexPen® (100 units/mL – 5 x 3 mL)
| - 0.4-1.0 units /kg/day
- Generally, 50% of daily dosing given as basal insulin, usually at night
- The other 50% is typically divided as prandial insulin
- Administer 30 minutes before meals
| - 4 units or 10% of usual basal dose, given once daily before largest meal of the day is recommended as initial dose
- If a1c less than 8% & patient is on basal insulin when regular insulin is initiated, consider decreasing basal insulin by same amount as initiated regular insulin
- Increase regular insulin dose by 1-2 units, or 10-15%, twice weekly until blood glucose goals are met
- If hypoglycemia occurs, determine cause, & decrease dose by 10-20%
|
Legend:
- Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; should be individualized for each patient
- No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
- Total daily doses of ALL insulin formulations combined is typically: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; non-obese patients may require less insulin than obese patients
- Non-obese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
Table 4. Adult Insulin Recommended Dosages for Single Insulin Products: Intermediate-Acting11,12,23,24| Drug Name | Dosage Form | Labeled Dosage Regimen for Type 1 Diabetes * | Labeled Dosage Regimen for Type 2 Diabetes * |
|---|
| Isophane insulin (NPH) | - Humulin® N vial (100 units/mL – 3 or 10 mL)
- Humulin® N KwikPen® (100 units/mL – 5 x 3 mL)
- Novolin® N vial (100 units/mL – 10 mL)
- Novolin N FlexPen (100 units/mL – 5 x 3 mL)
- Novolin® N KwikPen® (100 units/mL – 5 x 3 mL)
| - 0.4-1.0 units/kg/day
- Generally, 50% of daily dosing given as basal insulin, usually at night
- The other 50% typically divided as prandial insulin
- Administer once daily before bed or divided into twice daily regimen given 30-60 minutes before meal
| - 10 units or 0.1 to 0.2 units/kg/day given once daily before bed or divided into twice daily regimen given 30-60 minutes before meal
- Increase dosage by 2 units every 3 days until blood glucose goals are met
- If hypoglycemia occurs, determine cause, & decrease the corresponding dose by 10% to 20%
|
Legend:
- Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; should be individualized for each patient
- No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
- Total daily doses of ALL insulin formulations combined is typically: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; non-obese patients may require less insulin than obese patients
- Non-obese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
Table 5. Adult Insulin Recommended Dosages for Single Insulin Products: Long-Acting11,12,25-31| Drug Name | Dosage Form | Labeled Dosage Regimen for Type 1 Diabetes * | Labeled Dosage Regimen for Type 2 Diabetes * |
|---|
| Insulin degludec | Tresiba generic vial (100 units/mL – 10 mL)
Tresiba generic FlexTouch pen (100 units/mL – 5 x 3 mL; 200 units/mL – 3 x 3 mL) | Initially, administer 1/3 to 1/2 of total daily insulin dose once daily
Administer remainder as short-acting insulin & divided between each daily meal
Insulin naive patients generally require total daily insulin dose of 0.2 - 0.4 units/kg/day
Insulin degludec may be given any time of day; however, doses must be at least 8 hours apart | In adults naive to insulin, initiate with 10 units once daily
Insulin degludec may be given at any time of day; however, doses must be at least 8 hours apart
Titrate dosage every 3-4 days to achieve blood glucose & a1c goals in conjunction with short-acting insulin |
| Insulin detemir | - Levemir® vial (100 units/mL – 10 mL)
- Levemir® FlexTouch® pen (100 units/mL – 5 x 3 mL)
| - Initially, administer 1/3 to 1/2 of total daily insulin dose once or twice daily
- For once daily dosing, give with evening meal or at bedtime
- For twice daily dosing, give first dose in the morning and the second dose 12 hours later, with the evening meal, or at bedtime
- Administer the remainder as short-acting insulin and divided between each daily meal
- Insulin naive patients generally require a total daily insulin dose of 0.2 - 0.4 units/kg/day
- Insulin degludec may be given at any time of day; however, doses must be given at least 8 hours apart
| - 10 units or 0.1 to 0.2 units/kg/day given once daily in the evening or divided twice daily
- Increase dosage by 2 units every 3 days until blood glucose goals are achieved
- If hypoglycemia occurs, decrease dose by 10-20%
- For once daily dosing, give with evening meal or at bedtime
- For twice daily dosing, give first dose in the morning and the second dose 12 hours later, with the evening meal, or at bedtime
- Administer the remainder as short-acting insulin and divided between each daily meal
|
| Insulin glargine | - Basaglar KwikPen (100 units/mL)
- Basaglar Tempo Pen (100 un
- Lantus generic vial (100 units/mL – 10 mL)
- Lantus SoloStar pen (100 units/mL – 5 x 3 mL)
- Rezvoglar KwikPen (100 units/mL – 5 x 3 mL)
- Semglee vial (100 units/mL – 10 mL)
- Semglee 100 units/mL pen (100 units/mL – 5 x 3 mL)
- Toujeo SoloStar® pen (300 units/mL – 3 x 1.5 mL)
- Toujeo® Max SoloStar® pen (300 units/mL – 2 x 3 mL)
| - 0.4 to 1 unit/kg/day is the typical total daily insulin requirement
- In general, 50% of daily insulin is given as basal insulin (intermediate-acting or long-acting), usually at night
- The other 50% is divided and given as prandial insulin (rapid-acting or short-acting) before a meal
- Titrate dosage to achieve blood glucose and a1c goals in conjunction with short-acting insulin
| - 10 units or 0.1 to 0.2 units/kg/day once daily in patients not controlled on an oral antidiabetic medicine
- Increase dosage by 2 units every 3 days until blood glucose goals are achieved
- If hypoglycemia occurs, decrease dose by 10% to 20%
|
Legend:
- Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; should be individualized for each patient
- No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
- Total daily doses of ALL insulin formulations combined is typically: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; non-obese patients may require less insulin than obese patients
- Non-obese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
Table 6. Adult Insulin Recommended Dosages for Insulin Combination Products11,12,32-36| Drug Name | Dosage Form | Usual Dosage Regimen * | Maximum Recommended Dosage * |
|---|
| Insulin aspart protamine/insulin aspart | - NovoLog® Mix 70/30, generic vial (100 units/mL – 10 mL)
- NovoLog® Mix 70/30 FlexPen®, generic (100 units/mL – 5 x 3 mL)
| - Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; this should be individualized for each patient
- Total daily doses of ALL insulin formulations combined: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; nonobese patients may require less insulin than obese patients
- Nonobese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
| - No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
|
| Isophane insulin (NPH)/ regular insulin | - Humulin® 70/30 vial (100 units/mL – 3 or 10 mL)
- Humulin® 70/30 KwikPen® (100 units/mL – 5 x 3 mL)
- Novolin® 70/30 vial (100 units/mL – 10 mL)
- Novolin® 70/30 FlexPen (100 units/mL – 5 x 3 mL)
| - Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; this should be individualized for each patient
- Total daily doses of ALL insulin formulations combined: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; nonobese patients may require less insulin than obese patients
- Nonobese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
| - No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
|
| Insulin lispro protamine/insulin lispro | - HumaLog® Mix 50/50 vial (100 units/mL – 10 units)
- HumaLog® Mix 50/50 KwikPen® (100 units/mL – 5 x 3 mL)
- HumaLog® Mix 75/25 vial (100 units/mL – 10 mL)
- HumaLog® Mix 75/25 KwikPen®, generic (100 units/mL – 5 x 3 mL)
| - Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; this should be individualized for each patient
- Total daily doses of ALL insulin formulations combined: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; nonobese patients may require less insulin than obese patients
- Nonobese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
| - No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
|
Legend:
- Multiple or continuous insulin dosing may be required to maintain adequate glycemic control; should be individualized for each patient
- No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
- Total daily doses of ALL insulin formulations combined is typically: 0.5 to 1 units/kg/day
- Insulin needs may be affected by body weight; non-obese patients may require less insulin than obese patients
- Non-obese: 0.4 to 0.6 units/kg/day
- Obese: 0.8 to 1.2 units/kg/day
Table 7. Adult Insulin Recommended Dosages for Insulin/GLP-1 Receptor Agonist Combination Products11,12,37,38| Drug Name | Dosage Form | Usual Dosage Regimen | Maximum Recommended Dosage |
|---|
| Insulin glargine/lixisenatide | Soliqua® 100/33 pen (insulin glargine 100 units/mL and lixisenatide 33 mcg/mL – 5 x 3 mL) | 15 – 60 units/day | (15 – 60 units / 5 – 20 mcg) 60 units/20 mcg/day |
| Insulin degludec/liraglutide | Xultophy® 100/3.6 pen (insulin degludec 100 units/mL and liraglutide 3.6 mg/mL – 5 x 3 mL) | 10 – 50 units/day (10 – 50 units / 0.36 – 1.8 mg) | 50 units/1.8 mg/day |
Legend:
- GLP-1 = glucagon-like peptide-1
