1.1. Background

Insulin is a hormone that is typically produced and secreted from pancreatic beta cells in response to elevated blood glucose by binding to receptors found on the liver, skeletal muscle, and adipose tissue cells. Carbohydrate, protein, and fat metabolism are regulated by insulin through suppressing hepatic glucose production, stimulating tissue glucose uptake, and suppressing free fatty acid release from adipose tissue. Subsequently, blood glucose levels are reduced through insulin’s mechanism. 1-3

However, there is inadequate or no insulin secretion in type 1 diabetes mellitus (DM), and there is insulin deficiency and resistance in type 2 DM. Therefore, patients with type 1 DM require insulin treatment to survive; patients with type 2 DM may require insulin when other antidiabetic agents are not able to effectively control blood glucose levels. If either type 1 or 2 DM are left untreated and/or uncontrolled, chronic hyperglycemia may lead to micro- and macrovascular complications, such as retinopathy, nephropathy, neuropathy, hypertension, dyslipidemia, and cardiovascular disease. 1-7

Exogenous insulin products are FDA-approved for use in type 1 and 2 DM. These products are used to mimic the physiologic pattern of insulin secretion. Phase 1 is basal insulin secretion, which suppresses hepatic glucose production in order to maintain blood glucose levels throughout the day. Phase 2 is increased insulin secretion in response to carbohydrate intake in order to lower postprandial blood glucose levels. Patients with type 1 DM require both basal and preprandial insulin boluses, while patients with type 2 DM may require basal and/or preprandial insulin boluses in addition to oral antidiabetic agents, diet, exercise, and weight reduction depending on the severity of their disease and glycemic control. 1-7

Glycemic targets recommended by the American Diabetes Association (ADA) and American Association of Clinical Endocrinologists and American College of Endocrinology (AACE/ACE) guidelines are summarized in Table 1 2, 8, 9. However, these targets should be individualized based on patient factors, such as life expectancy, severity of disease, comorbidities, and hypoglycemic risk. 2,8,9

Table 1. 2021 ADA & 2020 AACE/ACE General Glycemic Target Recommendations2, 8-10
Glycemic TargetsADA – Type 1 and 2AACE/ACE – Adult Type 2
Hemoglobin A1c

Adults & Pediatrics: less than 7%
Adults greater than 65 years:

  • Healthy: less than 7.0-7.5%
  • Complex/ intermediate health: less than 8.0%
  • Very complex/ poor health: Avoid hypoglycemia & symptomatic hyperglycemia
Greater than or less than 6.5%
Preprandial blood glucose

Adults: 80–130 mg/dL
Pediatrics: 90–130 mg/dL*
Adults greater than 65 years:

  • Healthy: 80–130 mg/dL
  • Complex/intermediate health: 90-150 mg/dL
  • Very complex/ poor health: 100-180 mg/dL
Less than 110 mg/dL
Postprandial blood glucoseAdults: less than 180 mg/dLLess than 140 mg/dL
Bedtime blood glucose

Adults & Pediatrics: 90–150 mg/dL*
Adults Greater than 65 years:

  • Healthy: 80-180 mg/dL
  • Complex/ intermediate health: 100-180 mg/dL
  • Very complex/ poor health: 110-200 mg/dL
N/A

Legend:

  • ! Less stringent A1c goals of less than 7.5% may be appropriate in pediatric and adolescent patients who cannot articulate hypoglycemia symptoms; have hypoglycemia unawareness; lack access to analog insulins, advanced insulin delivery technology, and/or continuous glucose monitoring; cannot check blood glucose regularly, or have nonglycemic factors that increase A1c. A goal of less than 8.0% may be appropriate in pediatric an adolescent patients with a history of severe hypoglycemia, limited life expectancy, or where harms of treatment outweigh the benefits
  • * Recommendations carried over from 2019 ADA Standards of Medical Care in Diabetes since they are not presented in the 2021 guidelines.

1.2. Adults

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 NameDosage FormLabeled 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 NameDosage FormLabeled 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 NameDosage FormLabeled 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 NameDosage FormLabeled Dosage Regimen for Type 1 Diabetes *Labeled Dosage Regimen for Type 2 Diabetes *
Insulin degludecTresiba 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 NameDosage FormUsual 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 NameDosage FormUsual Dosage RegimenMaximum Recommended Dosage
Insulin glargine/lixisenatideSoliqua® 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/liraglutideXultophy® 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

1.3. Pediatrics

Safety and efficacy for inhaled insulin (Afrezza), insulin lispro/lispro protamine combinations (HumaLog Mix 50/50 and 75/25), insulin aspart/insulin aspart protamine combinations (NovoLog Mix 70/30), and insulin-GLP-1 combinations (Soliqua 100/33 and Xultophy 100/3.6) have not been studied or established in pediatric patients. 10-13, 14, 19, 32, 35, 36-38

The insulin aspart formulation sold under the trade name Fiasp was approved for pediatric use in patients 2 years of age or older in 2020.39

Recommended age requirements for insulin products approved in pediatric patients are summarized in the following tables.

Usual dosage regimens and maximum recommended dosages are similar to adult patients.

Table 8. Pediatric Insulin Recommended Dosages for Single Insulin Products: Rapid-Acting11-17
Drug NameDosage FormApproved Age Requirements *Maximum Recommended Dosage *
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® vial (100 units/mL – 10 mL)
  • NovoLog® FlexPen® (100 units/mL – 5 x 3 mL)
  • NovoLog® PenFill® cartridges (100 units/mL – 5 x 3 mL) for NovoPen Echo® device
Children greater than or equal to 2 years and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Insulin glulisine
  • Apidra® vial (100 units/mL – 10 mL)
  • Apidra® SoloStar® pen (100 units/mL – 5 x 3 mL)
Children greater than or equal to 4 years and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
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) for 
  • HumaLog® vial (100 units/mL – 3 mL)
  • HumaLog® KwikPen® (100 units/mL – 3 mL; 200 units/mL – 3 mL)
  • Humalog Tempo (100 units/mL – 5 x 3 mL)
Children greater than or equal to 3 years and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs

Legend:

  • No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Table 9. Pediatric Insulin Recommended Dosages for Single Insulin Products: Short-Acting11,12,20-22
Drug NameDosage FormApproved Age Requirements *Maximum Recommended Dosage *
Regular insulin
  • Humulin® R vial (100 units/mL – 10 mL; 500 unit/mL – 20 mL)
  • Humulin® R KwikPen® (500 units/mL – 2 x 3 mL)
  • Novolin® R vial (100 units/mL – 10 units)
  • Novolin® R FlexPen® (100 units/mL – 5 x 3 mL
No specific age requirement reportedNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs

Legend:

  • No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Table 10. Pediatric Insulin Recommended Dosages for Single Insulin Products: Intermediate-Acting11,12,23,24
Drug NameDosage FormApproved Age Requirements *Maximum Recommended Dosage *
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)
No specific age requirement reportedNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs

Legend:

  • No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Table 11. Pediatric Insulin Recommended Dosages for Single Insulin Products: Long-Acting11,12,25-31
Drug NameDosage FormApproved Age Requirements *Maximum Recommended Dosage *
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)
  • Children greater than 1 year and adolescents
  • Not recommended if require less than 5 units
No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Insulin detemir
  • Levemir® vial (100 units/mL – 10 mL)
  • Levemir® FlexTouch® pen (100 units/mL – 5 x 3 mL)
Children greater than 2 years and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Insulin glargine
  • Basaglar KwikPen (100 units/mL)
  • Basaglar Tempo Pen (100 units/ mL – 5 x 3 mL)
  • Lantus, generic vial (100 units – 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)
Children greater than 6 years and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs

Legend:

  • No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs
Table 12. Pediatric Insulin Age Requirements for Insulin Combination Products11,12,34
Drug NameDosage FormApproved Age Requirements *Maximum Recommended Dosage *
Isophane insulin (NPH) and regular insulin
  • Novolin® 70/30 vial (100 units/mL – 10 mL)
  • Novolin® 70/30 FlexPen (100 units/mL – 5 x 3 mL)
Children and adolescentsNo maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs

Legend:

  • No maximum recommended dosage to exceed; insulin and other antidiabetic drugs should be adjusted to target glycemic goals and meet patients’ needs