In the conversion from NPH to glargine U-100 for once-daily administration, how is the dosage adjusted?

When converting from NPH (Neutral Protamine Hagedorn) insulin to glargine U-100 for once-daily administration, it is generally recommended to keep the same total daily dose. This is because NPH and glargine have different pharmacokinetic profiles and dosing strategies.

NPH has a peak action and a duration that may not align with the relatively flatter profile of glargine, which provides a more consistent level of insulin throughout the day without significant peaks. During the conversion, while it may seem logical to alter the dosage due to differences in action, maintaining the same dose ensures that the patient’s glycemic control is preserved as they transition between insulins.

Thus, this approach minimizes the risk of both hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) during the switch in insulin types. This understanding is crucial for effective management of diabetes, particularly when making adjustments in insulin therapy.