Basal insulin

If changing from glargine insulin (Lantus, Basaglar), determir (Levemir), or degludec (Tresiba) to isophane insulin (NPH), dosing is 1:1, divided into two daily doses (e.g., 50:50 or 2/3 in the morning and 1/3 before dinner or at bedtime)12,13

or

Give once-daily dose of isophane insulin (enhances adherence, avoids weight gain, and reduces hypoglycemic events; compared with once-daily dosing, twice-daily or mealtime dosing increases weight gain by 10 to 12 lb (4.5 to 5.4 kg) per year and waist circumference by 2 cm per year, and causes four to eight episodes of moderate to severe hypoglycemia per year)14

If patient is not already receiving insulin, start on isophane insulin, 10 units per day or 0.1 to 0.2 units per kg per day, and titrate to achieve fasting blood glucose target; dosages of 0.4 to 0.5 units per kg per day should be divided into two daily doses15

Mealtime insulin

If changing from lispro (Humalog) or aspart (Novolog) to regular insulin (Humulin R), dosing is 1:1 with at least six hours between doses (e.g., a patient taking 4 units of aspart insulin before each meal would take 4 units of regular insulin 15 to 30 minutes before each meal); twice-daily dosing should be considered for patients who eat more frequently than every six hours (e.g., isophane insulin at breakfast and dinner only)