NPH Insulin Dosing Schedule

Standard Split-Dose Regimen

The American Diabetes Association recommends splitting the total NPH dose with 2/3 administered before breakfast and 1/3 administered before dinner for patients with diabetes 1, 2
When converting from bedtime-only NPH to a split regimen, the American Diabetes Association suggests reducing the total NPH dose to 80% of the current bedtime dose, then dividing according to the 2/3:1/3 ratio 1, 2
The American Diabetes Association recommends adding 4 units of short/rapid-acting insulin to each injection, or 10% of the reduced NPH dose, for prandial coverage 1, 2

The American Diabetes Association recommends beginning with bedtime administration at 10 units per day or 0.1-0.2 units/kg per day for patients starting NPH insulin 1, 2
The American Diabetes Association suggests titrating by increasing 2 units every 3 days to reach fasting plasma glucose goal without hypoglycemia 1, 2
If hypoglycemia occurs without clear cause, the American Diabetes Association recommends reducing the dose by 10-20% 1, 2

The American Diabetes Association recommends considering splitting to twice-daily NPH when A1C remains above goal despite optimized bedtime NPH dosing 1, 2
The American Diabetes Association suggests considering splitting to twice-daily NPH when adding prandial insulin coverage is needed 1, 2

For patients on tube feeding requiring NPH, the American Diabetes Association recommends considering splitting into twice or three times daily to cover continuous nutritional intake 4

The American Diabetes Association recommends not giving equal doses morning and evening—the 2/3:1/3 ratio accounts for greater insulin sensitivity overnight and reduces nocturnal hypoglycemia risk 1, 2
The American Diabetes Association suggests not maintaining the same total daily dose when converting from once to twice-daily—reduce to 80% of the bedtime dose first 1, 2