For doctors · Diabetes
Starting doses for type 2 and type 1, including a full basal plus mealtime start, a carbohydrate counter with Indian food portions, titration by fasting readings, dose conversions between insulins, and the move from an IV infusion to injections. It ends with a card your patient takes home.
For registered medical practitioners. These are starting points from prescribing information and guidelines, with the source shown for each. Adjust to the person in front of you. Adults only: for children, work with a paediatric diabetes team. Nothing you enter leaves this device.
| Lowest reading (mg/dL) | Change |
|---|---|
| Below 80 | −2 units |
| 80 to 110 | No change |
| 111 to 140 | +2 units |
| 141 to 180 | +4 units |
| Above 180 | +6 units |
Once a week. The pre-breakfast reading sets the dinner dose; the pre-dinner reading sets the breakfast dose. Biphasic insulin aspart 30 label (EU). Once a single evening dose reaches 30 units, split it into two equal doses.
| Medicine | When insulin starts |
|---|---|
| Metformin | Continue. |
| SGLT2 inhibitor | Continue. Explain the ketone risk if insulin is later cut sharply. |
| GLP-1 medicine or tirzepatide | Continue. ADA 2026 prefers these before insulin, and recommends combining them with insulin when insulin is needed. |
| Sulfonylurea | |
| DPP-4 inhibitor | Stop if a GLP-1 medicine is used. Otherwise it can continue with basal, and stops when insulin is intensified. |
| Repaglinide | Stop when mealtime insulin starts. |
| Pioglitazone | May lower insulin needs. Watch for fluid retention and weight gain. Avoid in heart failure. |
ADA 2026: usual needs 0.4 to 1.0 units/kg/day; 0.5 is typical when metabolically stable; 0.2 to 0.6 at diagnosis, lower in the remission (“honeymoon”) phase. Basal 30 to 50% of the total. Carbohydrate ratio (500 ÷ total) and correction factor (1800 ÷ total, in mg/dL) from ISPAD 2024. Adjust by about 1 to 2 units or 10% at a time.
Pick what is on the plate. Carbohydrate per portion is approximate, worked out from the ICMR-NIN Indian food composition tables (IFCT 2017) for a typical home portion. Recipes and portion sizes vary: weigh the rice and roti for the first week or two.
Meal dose = carbohydrate ÷ ratio. Correction = (sugar − target) ÷ correction factor, added only when the sugar is above the target and no rapid-acting insulin was taken in the last 3 hours (it is still working, and doses stack). The ratio and factor fill in from the 500 and 1800 rules (ISPAD 2024) and should then be set from the patient's own readings: a 2-hour reading within about 30 mg/dL of the pre-meal one means the ratio is right. Doses round down to the pen step.
| Insulin | Timing (label) |
|---|
| Injected dose at that meal | Starting inhaled dose |
|---|---|
| Up to 3 units | 4 units |
| 4 to 5 units | 8 units |
| 6 to 7 units | 12 units |
| 8 units or more | 16 units |
US label, January 2026. Insulin-naive: 4 units at each meal. More on inhaled insulin in India.
Whatever the conversion, check fasting and pre-meal readings closely for the first 1 to 2 weeks, and titrate from there. Detemir is being withdrawn by its maker (UK supply ends in December 2026, per Diabetes UK). Check its availability in India: detemir patients may need one of these moves.
Use a recent 6 hours on a steady rate. If the patient was eating on the drip, that total includes meal cover, so lean to the lower figure. ADA Standards, Diabetes Care in the Hospital: basal at 60 to 80% of the daily infusion dose. Schmeltz et al. (2006) tested 40, 60 and 80%; 80% gave the most readings in range. Steroids, feeds and sepsis change needs quickly.
What your patient takes home: the plan from the tab above, how to adjust it, lows, sick days, pen technique and storage. Check it, then print.
Found an error? Write to info@caspianhealthcare.in.