NEW YORK (Reuters Health) – Weight-based insulin doses up to 0.6 unit/kg are associated with a low risk of hypoglycemia, according to a report in the June 23rd advance issue of Diabetes Care.
“Our study provides evidence for the safety of daily insulin doses up to 0.6 unit/kg,” Dr. Daniel J. Rubin from Temple University School of Medicine, Philadelphia, Pennsylvania told Reuters Health in an email. “I hope this will encourage more physicians to be comfortable using weight-based insulin dosing.”
Dr. Rubin and colleagues investigated the relationship between insulin dose and hypoglycemia in a retrospective, case-control study of 1990 diabetic patients admitted to hospital wards.
The unadjusted odds of hypoglycemia increased with insulin doses above 0.2 unit/kg, and patients who received insulin doses of 0.6 unit/kg or more faced increased odds of hypoglycemia. The adjusted odds of hypoglycemia were not higher among patients who received 0.2 to 0.6 unit/kg.
The odds of hypoglycemia were 3 times higher among patients who did not receive sliding scale insulin than among those who did, and there was a trend toward higher odds among patients who received NPH compared with patients who received glargine or short-acting insulin.
Hypoglycemia was not more common among patients given insulin with an oral diabetes medication than among those given insulin alone.
“0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low,” the researchers note.
“Some patients, however, require more than 0.6 unit/kg to treat hyperglycemia and do not experience any hypoglycemia,” Dr. Rubin said. “If there is any concern for hypoglycemia, it is reasonable to use doses <0.6 unit/kg. Insulin dosing for individual patients must be done on a case-by-case basis.”
“Our data are consistent with the ADA recommendation to provide 0.6 unit/kg of subcutaneous insulin to non-ICU patients and with randomized controlled trials of basal-bolus insulin that reported low rates of hypoglycemia with doses less than or equal to 0.6 unit/kg,” Dr. Rubin added.
Diabetes Care.
