Version July 2025
| Indication | Suggested starting doses for insulin |
| Patient with high blood glucose on OGTT, or random hyperglycemia with worsening lung function and weight loss | Long-acting (basal) insulin 0.1 units/kg every morning. For patients on glucocorticoids, use starting dose of insulin 0.2 units/kg. Increase dose by increments of 0.1 units/kg, aiming for postprandial blood glucose <140 mg/dL (7.8 mmol/L), without hypoglycemia. |
| Inability to reach glycemic targets on basal insulin alone | Add prandial insulin (0.5 units rapid-acting insulin for each 15 g carbohydrate, given just prior to the meal), in addition to basal insulin. |
| Hyperglycemia in hospital for infection or pulmonary exacerbation, or patient on glucocorticoids | Increase starting dose of basal insulin to 0.2 units/kg. Most patients also require prandial insulin during intercurrent infections. |
| High blood glucose in patient on overnight enteral feeds | Basal insulin (glargine) 0.1 units/kg at bedtime, in combination with a rapid-acting or regular insulin*. |
| Difficulties reaching glycemic goals with above regimens, and/or desire for more convenient or physiologic insulin replacement | Continuous subcutaneous insulin infusion (insulin pump). |
A1C: hemoglobin A1c (glycated hemoglobin); NPH: neutral protamine hagedorn; OGTT: oral glucose tolerance test.
* An alternative is NPH (also known as isophane insulin) given alone, but it has a very variable pharmacodynamic response compared with glargine.
