Table 2.
Variables and potential effects on insulin analog dosing
| Variable | Potential effect | Action needed* |
|---|---|---|
| Insulin dose24,37,38 | Duration of action increases with increasing doses | Dose adjustments should be more conservative as the administered dose increases |
| Injection site21,23,29,32,40–43 | Absorption varies with site of injection, heat, muscle activity; abdomen has least variability | Rotate injection sites within the same body region to decrease variability and improve predictability of response |
| Older age4,44,45 | Increased insulin effects with possible decreased clearance and increased AUC | Match carbohydrate meal content to insulin dose for rapid-acting insulins; initial dose and dose adjustments should be conservative |
| Racial and ethnic groups4,21,46–48 | No difference in absorption for detemir or aspart; more rapid absorption for glargine and higher initial exposure for glulisine in Japanese patients | Data are limited; no adjustment needed for detemir or aspart; adjustments may be needed for Japanese patients receiving glargine or glulisine |
| Obesity13,20,21,49–51 | Slower absorption and reduced exposure of insulin analogs with increased subcutaneous fat; decreased clearance may occur with some insulin analogs | Higher starting doses may be required because of insulin resistance, but not consistent across insulin analogs |
| Renal dysfunction4,19–21,23,52–55 | Insulin clearance decreased, insulin levels increase, metabolic responses to insulin decrease | Dose requirements may decrease for patients with moderate to severe renal dysfunction |
| Hepatic dysfunction4,19–21,23,52,56 | Data are limited; hepatic clearance of insulin decreased | Dose requirements may decrease in severe hepatic dysfunction and be unchanged in mild to moderate dysfunction |
| Pregnancy57,58 | No data available for insulin analogs; insulin resistance increased | Dose requirements may increase |
| Exercise59–61 | Increased absorption possible from muscle sites | May need to reduce doses of rapid-acting analogs before exercise |
*
Note: Frequent self-monitoring of blood glucose is recommended for patients with any of these variables (which could potentially affect insulin analog dosing) until the patient is on a stable dose of the insulin analog.
Abbreviation: AUC, area under the curve.