Insulin dosing approach for type 1 diabetes
Support healthy lifestyle behaviours, deliver diabetes
self-management education and support, and address
social determinants of health to meet individualized
treatment goals
initiation and titration of insulin
initiation: 0.4-0.5 titration: Up titrate or
units/kg/day divided down titrate as necessary,
equally between basal and adjusting basal and
prandial
prandial doses based on
individualized goals
Reassess frequently using continuous glucose
monitoring (CGM) and/or self-monitoring of blood
glucose (SMBG) to determine
individual needs for prandial and basal dosing balance
If A1C, CGM metrics, or SMBG not at goal
If hypoglycaemia is present, If hyperglycaemia is present,
adjust basal and/or prandial adjust basal and/or prandial
insulin based on the timing of insulin based on the timing and
hypoglycaemia, decrease the extent of hyperglycaemia (e.g.,
dose by 1-4 unites or 5-10% 1 unit or 10% dosage
dosage adjustment adjustments)
If fasting hyperglycaemia If postprandial hyperglycaemia is present, assess
is present, review and educate to ensure prandial administration is
overnight glucose appropriately timed and adjusted for nutrient
pattern and adjust basal intake (dosing may be fixed based on general
insulin, if appropriate intake or variable based on macronutrient and/or
glycaemic trends, depending on individual
preference and ability)
Support healthy lifestyle behaviours, deliver diabetes
self-management education and support, and address
social determinants of health to meet individualized
treatment goals
initiation and titration of insulin
initiation: 0.4-0.5 titration: Up titrate or
units/kg/day divided down titrate as necessary,
equally between basal and adjusting basal and
prandial
prandial doses based on
individualized goals
Reassess frequently using continuous glucose
monitoring (CGM) and/or self-monitoring of blood
glucose (SMBG) to determine
individual needs for prandial and basal dosing balance
If A1C, CGM metrics, or SMBG not at goal
If hypoglycaemia is present, If hyperglycaemia is present,
adjust basal and/or prandial adjust basal and/or prandial
insulin based on the timing of insulin based on the timing and
hypoglycaemia, decrease the extent of hyperglycaemia (e.g.,
dose by 1-4 unites or 5-10% 1 unit or 10% dosage
dosage adjustment adjustments)
If fasting hyperglycaemia If postprandial hyperglycaemia is present, assess
is present, review and educate to ensure prandial administration is
overnight glucose appropriately timed and adjusted for nutrient
pattern and adjust basal intake (dosing may be fixed based on general
insulin, if appropriate intake or variable based on macronutrient and/or
glycaemic trends, depending on individual
preference and ability)
