India · Basal-Bolus · Correction Factor · Sliding Scale · Glargine · NPH · Regular · Aspart · Lantus · Actrapid · Insulatard
| Blood glucose (mg/dL) | Insulin dose (units) | Action |
|---|
Rapid-acting — onset 15min, peak 1–2h
Aspart: NovoRapid · Novorapid FlexPen
Lispro: Humalog · Lupsulin R
Short-acting (Regular) — onset 30min, peak 2–4h
Actrapid · Huminsulin R · Wosulin R
Intermediate (NPH) — onset 2h, peak 4–8h
Insulatard · Huminsulin N · Wosulin N
Long-acting (Basal) — onset 2–4h, no peak
Glargine: Lantus · Basaglar · Glaritus
Detemir: Levemir
Degludec: Tresiba
BG <70 mg/dL: Treat with 15g carbs. Recheck in 15 min. Repeat if still <70.
BG <54 mg/dL / unconscious: IV dextrose 25ml D50 immediately.
⚠️ Never give insulin correction for BG <100 mg/dL
⚠️ Hold bolus if patient not eating
Insulin therapy is essential for all patients with Type 1 diabetes and is progressively required by the majority of patients with Type 2 diabetes as β-cell function declines over time. India has one of the highest burdens of diabetes globally (estimated 77 million adults with T2DM, ICMR 2023) and insulin therapy is widely available through government and private channels. However, insulin initiation anxiety — both from patients and physicians — is a significant barrier to timely intensification of therapy in India. Understanding the 1800 rule (Insulin Sensitivity Factor), basal-bolus concepts, and correct injection technique is essential for effective diabetes management.
All insulin calculations begin with the Total Daily Dose (TDD). Starting TDD by weight: Type 1 diabetes: 0.4–0.5 units/kg/day initially (honeymoon phase: 0.2–0.3 units/kg/day). Type 2 diabetes — insulin naïve: 0.3–0.5 units/kg/day. Type 2 — poorly controlled on maximal oral therapy: 0.5–1 unit/kg/day. For a 60 kg T2DM patient: starting TDD = 60 × 0.4 = 24 units → round to 24 units (12 basal + 12 bolus split across 3 meals = 4 units per meal).
The ISF (Insulin Sensitivity Factor, also called correction factor) estimates how much 1 unit of rapid-acting insulin lowers blood glucose in mg/dL: ISF = 1800 ÷ TDD. For regular insulin use the 1500 rule: ISF = 1500 ÷ TDD. Correction dose = (Current BG – Target BG) ÷ ISF. Example: TDD = 40 units, ISF = 1800 ÷ 40 = 45. If BG = 270, target = 120: correction = (270–120) ÷ 45 = 3.3 → give 3 units rapid-acting. The ISF should be validated against the patient's actual glucose response and adjusted over time.
NPH insulin (Insulatard, Huminsulin N, Wosulin N) remains widely used in India due to its significantly lower cost compared to insulin analogues. NPH requires BD (twice daily) dosing — typically pre-breakfast and pre-dinner — and has a pronounced peak at 4–8 hours, increasing nocturnal hypoglycaemia risk. Long-acting analogues (glargine: Lantus, Basaglar, Glaritus; detemir: Levemir; degludec: Tresiba) are peakless, once-daily (glargine/degludec) or once-to-twice-daily (detemir) preparations with significantly lower nocturnal hypoglycaemia. The Jan Aushadhi scheme in India now includes some biosimilar insulins at reduced cost. The NPPA has introduced price controls on insulin in India — check current government pricing for patient affordability.