27th May 2025

Insulin therapy

Insulin therapy should be started immediately after diagnosis, it aims to mimic physiological insulin release by using a basal bolus regime or a continuous infusion with an insulin pump.

The total daily dose of insulin can vary from 0.5 to 1 units/kg/day in children, 0.2 to 0.4 units/kg/day in adults and up to 1.5 units/kg/day during puberty. Usually, one half of the total daily dose should be given as basal insulin and one half as bolus dosing which is divided and given before meals. 

Insulin regimens 

• Offer the patient a multiple daily injection basal-bolus insulin regimen from diagnosis over twice-daily mixed, basal only or bolus only insulin regimens.
• A combination of long-acting insulin (insulin detemir, degludec, or glargine) for basal dosing and rapid-acting insulin (insulin lispro, aspart or gluisine) for bolus dosing is recommended for patients.

Basal insulin therapy 

• Twice daily insulin detemir is recommended by NICE or alternatives are recommended as below.
• Once daily insulin glargine if the patient cannot tolerate insulin detemir or has a strong preference for once-daily basal injections.
• Once daily insulin degludec if there are concerns about nocturnal hypoglycaemia .
• Once daily ultra-long acting insulin degludec if the patient needs help from a carer to administer injections.

Bolus dosing 

• Rapid acting insulin analogues injected before meals are the insulin of choice for bolus dosing over rapid-acting soluble human or animal insulins.

Patients should be reminded to rotate injection sites in the same part of the body, most commonly the lower abdomen, to prevent lipodystrophy which can cause poor insulin absorption and poor control of blood glucose.

Other considerations 

• Insulin pumps (continuous subcutaneous insulin infusion, CSII) may be considered for patients in which MDI regimens are not appropriate or unsuccessful. 
• NICE recommend adding metformin if the BMI >- 25kg/m^2