What’s A Correction Factor? An Insulin Sensitivity? A Ratio?
Share: A Correction Factor (sometimes called insulin sensitivity), is how much 1 unit of rapid acting insulin will generally lower your blood glucose over 2 to 4 hours when you are in a fasting or pre-meal state. However, you should keep in mind: this is an estimate it may need to change as your baseline dose changes expect variations - sometimes 1 unit will lower it by more, and other times 1unit will lower it by less! calculating how much 1 unit of insulin will drop your blood sugar is a trial and error process, and sensitivity to insulin varies with the individual To get your total daily dose, add up all your usual meal time insulin and basal insulin. For example, Tom wants to calculate his correction factor: daily insulin dose: 8 units at breakfast, 6 units at lunch,10 at dinner and N/NPH 8 units at breakfast and 18 units at 10 pm Total Daily Dose (TDD) = 8 + 8 + 6+ 10 + 18 = 50 Correction Factor (CF) = 100/50 = 2 Therefore, one unit of rapid acting insulin would lower Tom’s blood sugar by 2 mmol/L over the next 2 to 4 hours. The average adult needs approximately 1 unit of insulin for every 2 mmol increase in blood sugar, but this can vary a lot between individuals: some people need 1 unit of insulin for every 1 mmol/L increase in blood sugar others need 1 unit of insulin for every 3 -5 mmol/L increase in blood sugar Using your CF before meal doses Before meal means there has been about 4 hours or more since you last ate or took an insulin dose for carbohydrate containing food or beverage. The correction factor or insulin sensitivity can be used to make a scale for pre meal insulin doses. BG Breakfast Lunch Dinner Bed Basal < 3.9 -2 -2 -2 Snack 4.0 - 5.9 Baseline Baseline Baseline Baseline Baseline 6.0 - 7.9 Baseline Baseline Baseline Baseline Baseline 8.0 – 9.9 Continue reading >>
All You Need To Know About Insulin Sensitivity Factor
Insulin is a hormone that plays an important role in the body's metabolism by controlling blood sugar levels and other processes. It is produced by beta cells in the pancreas and released it into the bloodstream after we eat to enable some body cells, such as muscle, fat, and heart cells, to absorb the sugar from the food we eat. Insulin also helps store glucose in the liver as glycogen when it is not needed, so it can be released when blood sugar levels are low or when more energy is needed. Therefore, insulin is essential for regulating blood sugar, ensuring that levels remain within certain limits and do not climb too high or fall too low. What is insulin sensitivity factor? Insulin sensitivity factor, or correction factor, refers to the number of milligrams per deciliter (mg/dl) fall in blood sugar levels caused by taking 1 unit of insulin. Knowing this number can help people with type 1 diabetes lower their blood sugar levels when they are out of their target range. This is usually added to the premeal insulin dose and is based on how much higher the person's blood sugar level is compared to their target. Target blood sugar levels need to be determined in discussions with a doctor. According to the American Diabetes Association, they should be as close as possible to healthy non-diabetic levels of: Between 70 and 130 mg/dl before a meal No higher than 180 mg/dl up to 2 hours after a meal Insulin treatment plans vary, but most people with type 1 diabetes are now on a basal-bolus insulin routine. A basal-bolus insulin routine involves injecting a longer-acting form of insulin to keep blood sugar levels stable between meals and when sleeping and injections of faster-acting insulin to cover meals. For people on a pump, an amount of fast-acting insulin is delivered thro Continue reading >>
How To Determine Your Insulin Sensitivity Factor
For many people with diabetes, insulin injections are the key to keeping their blood sugar at normal levels. Getting the right amount of insulin can seem a bit tricky at first. This is where you’ll need to do some math to get the dose just right. The pancreas makes the hormone insulin. Insulin helps the body use sugar as an energy source. It also helps balance your blood glucose levels. People with type 1 diabetes don’t make enough insulin. People with type 2 diabetes don’t properly use the insulin their bodies make. Taking insulin is necessary for people with type 1 diabetes, but it can also be important for people who have type 2 diabetes. An insulin dose that’s too high could lower your blood sugar too much. This can cause hypoglycemia. Hypoglycemia occurs when your blood sugar falls below 70 milligrams per deciliter (mg/dL). Hypoglycemia can lead to a loss of consciousness and seizures. Learn more: Humalog vs. NovoLog: Important differences and more » An insulin dose that’s too low may not bring your blood sugar to the target level. The resulting high blood sugar is called hyperglycemia. Hyperglycemia can lead to serious complications over time that can affect your: heart kidneys eyes nerves other organs You’ll need to know how sensitive you are to insulin to know the right dose of insulin to take. In other words, you’ll need to know how much insulin you need to lower your blood sugar by a certain amount. Insulin sensitivity isn’t the same for everyone. Some people with diabetes are more sensitive to insulin that others. In general, people with type 1 diabetes are more sensitive to insulin than people with type 2 diabetes. Your sensitivity to insulin can vary during the day based on your level of activity and your body’s rhythm of daily hormone se Continue reading >>
Switching To Humalog? Try These Helpful Hints
The new fast-acting insulin Humalog is finally here. Since Lilly’s introduction of the insulin many people have been switching over. However, Humalog can produce unexpected surprises in blood sugar control. This column explains several important differences in the action of this new insulin and suggests ways to best utilize Humalog. Almost everyone who is switching to Humalog is doing so to replace their Regular insulin. Regular is often thought of as “meal” or “high blood sugar” insulin. But its action time of five to eight hours more closely resembles a long-acting insulin. After switching from Regular to Humalog, many people have found they require fewer units of the new insulin to cover the same food. Fewer units may also be needed to lower high blood sugars. Others have discovered that when mealtime doses are lowered, they need to raise their long-acting insulin to replace some of the lost meal dose. Significant Timing Differences The Regular insulin most people take for breakfast has also been lowering their after-lunch blood sugars. This Prolonged action is no longer seen with Humalog. Several patients and colleagues have found they need extra long-acting insulin in the morning after switching to Humalog to keep their afternoon and pre-dinner readings down. Another alternative is to use extra Humalog to cover lunch. When Humalog is given before meals, it acts only during the time when most meals will be raising blood sugar. Its action is gone before the next meal begins, and most importantly for many, before bedtime. This eliminates many nighttime lows. But with the loss of the longer action of the dinner-time Regular, more evening long-acting insulin may also be needed to keep pre-breakfast blood sugar levels down. These significant timing differences Continue reading >>
New Digital Tool To Facilitate Subcutaneous Insulin Therapy Orders: An Inpatient Insulin Dose Calculator
Abstract: Abstract: Background: Inpatient hyperglycemia is associated with adverse outcomes in hospitalized patients, with or without known diabetes. The adherence to American College of Endocrinology (ACE) and American Diabetes Association (ADA) guidelines recommendations for inpatient glycemic control is still poor, probably because of their complexity and fear of hypoglycemia. Objective: To create a software system that can assist health care providers and hospitalists to manage insulin therapy orders and turns them into a less complicated issue. Methods: A software system was idealized and developed, according to recommendations of major consensus and medical literature. Results: The software was developed as an HTML application that could be readily accessed through a network using a workstation, tablet or smartphone. The software initial total daily dose of insulin was 0.4 units/kg and could be modified by distinct factors, such as age, renal and liver function, and high dose corticosteroids use. Insulin therapy has consisted of basal (NPH, glargine or detemir insulin), prandial and correction insulin (regular, lispro, aspart or glulisine insulin), according to nutritional support, glycemic control and outpatient treatment for diabetes. Sensitivity factor was based on 1800 Rule for rapid-acting insulin, and the 1500 Rule for short-acting insulin. The calculator system has allowed insulin dose readjustments periodically, according to the average blood glucose (BG) measurements. For patients who were insulin-naïve or in use of outpatient insulin treatment with total daily dose less than 0.2 units/kg, and initial BG level less than 250mg/dL, we have considered the initial treatment with a step-wise approach with prandial insulin and correction dose. After reevaluati Continue reading >>
Insulin From Patient Weight
Total Daily Insulin: 30 Units daily insulin divided into: 15 Units basal insulin (glargine/Lantus) 5 Units premeal insulin (aspart) before breakfast, lunch, & dinner --> 15 total premeal Correction Factor: 60 (mg/dL estimated blood glucose decrease after 1 unit SQ insulin) ⇑ ⇑ Lower the limit ⇑ ⇑ For premeal glucose less than 70: hold premeal insulin, give juice and call PCP For premeal glucose from 70 to 149: give 0 additional units aspart insulin For premeal glucose from 150 to 209: give 1 additional units aspart insulin For premeal glucose from 210 to 269: give 2 additional units aspart insulin For premeal glucose from 270 to 329: give 3 additional units aspart insulin For premeal glucose from 330 to 389: give 4 additional units aspart insulin For premeal glucose from 390 to 449: give 5 additional units aspart insulin For premeal glucose 450 or greater: give 6 additional units aspart insulin and call PCP ⇓ ⇓ Raise the limit ⇓ ⇓ Links to some related articles/sites: Diabetes.net discussion of the 1800 rule and correction factors NEJM's Clinical Practice: Management of Hyperglycemia in the Inpatient Setting (This offers a slighly different approach) PUBMED: Journal of Endocrinology Managmeent of Inpatient Hyperglycemia PUBMED: Journal of Hospitalist medicine Study looking at starting aspart in the ED PUBMED: Hospital management of hyperglycemia Continue reading >>
“rule Of 1500”
The “Rule of 1500” helps figure out how much 1 unit of Regular (R) insulin should lower your blood sugar. This rule only works with regular insulin. Divide 1500 by your Total Daily Insulin Dose (For All Types of Insulin you Use). Example: 1500/35 Units (For someone using 18 Units R Daily & about 17 units N total per day) = 42.8. 1 unit of Regular (R) insulin should lower your blood sugar by about 42.8 points. If your blood sugar is 285 and your target is 120, your correction dose would be about 4 units. Example: (285-120) = 165 / 42.8 = 3.8 units (round to 4 units) Continue reading >>
The Initial Assessment Of Daily Insulin Dose In Chinese Newly Diagnosed Type 2 Diabetes
Copyright © 2016 Jing Ma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. It has been well accepted that insulin therapy is the ideal treatment for newly diagnosed diabetic patients. However, there was no study about assessment of the initial insulin dosage in new onset Chinese patients with type 2 diabetes. Research Design and Methods. 65 newly diagnosed patients with type 2 diabetes (39 males/26 females; HbA1c ≥ 11.80 ± 0.22%) were investigated. All patients had random hyperglycaemia (at 21.8 ± 3.9 mmol/L) on the first day of admission and received insulin infusion intravenously (5 U/per hour). When the blood glucose level dropped to around 10 mmol/L, patients were then transferred to continuous subcutaneous insulin infusion (CSII). The reduction of blood glucose levels in response to per unit of insulin (RBG/RI) was recorded. The target glucose level was achieved in about 3 days. The total daily insulin dose (TDD) and basal insulin dose (TBD) were calculated. Results. TDD was 45.97 ± 1.28 units and TBD was 19.00 ± 0.54 units. TBD was about 40% of the total daily insulin requirement. There was a negative correlation between the ratio of RBG/RI and TDD. Conclusions. TDD was correlated with blood glucose reduction in response to intravenous insulin infusion in Chinese new onset patients with type 2 diabetes. 1. Introduction It has been reported that the prevalence of diabetes in Chinese adults was up to 11.6% by the China Noncommunicable Disease Surveillance Group in 2013 [1]. Patients with type 2 diabetes in Asian country mainly have impaired β-cell function rather than Continue reading >>
Helpful Hints For Humalog:
WHAT YOU NEED TO KNOW by John Walsh, P.A., C.D.E., and Ruth Roberts, M.A. Copyright--1996 by Diabetes Services, Inc. The new, fast insulin Humalog, is finally here. Since the introduction of Lilly's new insulin, many people have been switching over. This is the first insulin produced since 1921 that can really cover most meals, and its speed of action offers users more flexibility and control. This article provides helpful hints for safety and success when starting this new product. Almost everyone who is switching to Humalog is doing so to replace their Regular insulin. Regular is often thought of as "meal" Regular or "high blood sugar" Regular, but its action time of five to eight hours more closely resembles a long-acting insulin. After switching from Regular to Humalog, many people have found that fewer units of Humalog are needed to cover the same food. Fewer units may also be needed to lower high blood sugars. Others have discovered that as meal doses are lowered, they need to raise their long-acting insulin to replace some of the lost meal dose. The Regular insulin most people take for breakfast has, in effect, been lowering their after-lunch blood sugars as well. This prolonged action is no longer seen with Humalog. Several of my (John's) patients and several diabetes colleagues have found they need extra long-acting insulin in the morning after switching in order to keep the afternoon and pre-dinner readings down. Another alternative is to use extra Humalog to cover lunch. When given before most meals, Humalog will cover these meals only during the time they are raising the blood sugar. Its action is gone before the next meal begins, and most importantly for many, before going to bed. This eliminates many nighttime lows. But with the loss of the longer action o Continue reading >>
Effects Of Application Of Multiple Dose Insulin And Treatment With Insulin Pump On The Insulin Sensitivity Factor / Original Article
Abstract Objective: Insulin sensitivity factor is defined as amount of blood glucose (mg/dl) decreased by 1 unit of rapid or short acting insulin. Methods: There are 2 frequently used methods to establish insulin sensitivity factor. They are called rule of 1500 and rule of 1800. The present study included a total of 30 patients including 22 women and 8 men who were admitted to our clinic with brittle type I diabetes patients between 2001 and 2003. Result: In the present study, we observed that 1 unit of insulin reduced blood glucose by 38.60 ± 11.29 mg/dl in the group of patients using multiple dose insulin therapy (MIT); it was observed that 1 unit of insulin reduced blood glucose by 55.93 ± 37.78 mg/dl in the same group of patients when treatment with insulin pump (IP) was applied to these patients. Total insulin dose decreased by 16% and insulin sensitivity factor increased by 44% with passing to IP from MIT. Conclusions: It has been shown that IP therapy provides better insulin sensitivity factor than MIT therapy with brittle type I diabetics patients. Turk Jem 2007; 11: 111-3 Key words: Type I Diabetes Mellitus, Insulin sensitivity factor Özet Amaç: İnsülin duyarlılık faktörü 1 ünite hızlı veya kısa etkili insülin ile kan glikoz düzeyindeki azalma miktarı olaraktanımlanmıştır. Yöntem: İnsulin duyarlılık faktörünü belirlemede sık kullanılan 2 yöntem, 1500 kuralı ve 1800 kuralı olarak adlandırılmıştır. Bu çalışma 2001 ve 2003 yılları arasında kliniğimize brittle tip diyabet tanısı ile başvuran, 22 kadın, 8 erkek, toplam 30 hastada gerçekleştirilmiştir. Bulgular: Bu çalışmada, multipl insülin injeksiyonu uygulanan grupta, 1 ünite insülin, kan glikozunu 38.60±11.29 mg/dl azaltmıştır. Aynı gruba, insülin po Continue reading >>
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
Calculating Your Insulin Sensitivity Factor (isf) And Your Carb:insulin Ratio
CALCULATING YOUR INSULIN SENSITIVITY FACTOR (ISF) Your Diabetes Team may use any of the following methods to help find your ISF: 1. Insulin/Blood Glucose Formula (One unit of rapid or short-acting insulin for every 50 mg/dl increase or decrease in your blood glucose level). 2. Rule of 1500 – if you are using shortacting insulin (Regular). 3. Rule of 1700 – if you are using rapidacting insulin (Humalog®, Novalog®, Apidra®). ISF Method I – Insulin/Blood Glucose Formula With ISF Method I, you take one unit of rapid or short-acting insulin for every 50 mg/dl increase or decrease in your blood glucose level. EXAMPLE: Blood glucose target is 100 mg/dl. John’s pre-lunch blood glucose is 180 mg/dl and his Insulin Sensitivity is 50. His reading shows that he is above his target by 80 mg/dl. [180 mg/dl – 100 mg/dl = 80 mg/dl] He should take 1 (1.5 if you measure 1/2 units) extra units at lunch. If his usual dose of rapid or short-acting insulin at lunch were 12 units, he would increase it by one and take 13 or 13.5 units. PRACTICE PROBLEMS: Blood glucose target: 100 mg/dl Susan’s pre-lunch blood glucose is 205 mg/dl. Her reading shows that she is above her target by 105 mg/dl [205 mg/dl – 100 mg/dl = 105 mg/dl] Q – How many extra units should Susan take? 105 mg/dl / 50 = 2 units A – She should take 2 extra units. In this case she should take a total of 14 units. *** CALCULATING YOUR CARB:INSULIN RATIO A carb:insulin ratio is the amount of rapid or short acting insulin you need to match or “cover” the amount of carbohydrate you eat. The Rule of 500: Add up all the insulin given for 24 hours and divide it into 500. The answer is your carb:insulin ratio. EXAMPLE: Your total insulin dose is 50 units. 500 divided by 50 = 10 Your carb: insulin ratio is 10:1 Tom Continue reading >>
Nsulin Sensitivity & Carbohydrate Ratio Calculator
The Insulin Sensitivity Factor is the number of mg/dL one unit of insulin lowers glucose: 1500* / Total Daily Dose of Insulin = ISF The Carbohydrate Ratio is the number of carbohydrate grams covered by one unit of insulin: 450 / Total Daily Dose of Insulin To use the insulin sensitivity factor calculate the difference between the current blood sugar (glucose) and the desired blood sugar. Then divide the result by the sensitivity factor. The result is the amount of insulin that needs to be added or subtracted from the premeal insulin dose. Example: Current blood sugar is 140, target blood sugar is 100. Insulin sensitivity factor is 20. Correction = (140-100)/20 = 2 *The 1500 Rule was developed by Dr. Paul C. Davidson, Medical Director of the Diabetes Treatment Center in Atlanta. All calculations must be confirmed before use. The suggested results are not a substitute for clinical judgment. Neither OBFocus.com nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Continue reading >>
Diabetes And Nutrition
Sort correcting hypoglycemia -blood sugar < 70 -1/2 cup juice -give 15 g carbohydrate! -wait 15 min, recheck level -if level still low consume another 15 g carb, recheck 15 min later -recheck 1 hour after treating a low -extreme cases of unconsciousness: give glucagon! -hospitalized patients: give D50 -DO NOT consume high fat for low, can delay response 1500/1800/2000 rule -estimates the point drop in mg/dL for every unit of rapid-acting insulin taken -aka Insulin sensitivity or correction factor -based on TDD (total daily dose) -Type 1 -insulin sensitivity = Amt of insulin required to reduce blood glucose X units on the meter -1 unit insulin will reduce glucose 50 points -1500 rule estimates point drop for every unit of regular insulin taken -1800 rule for users of insulin ANALOGS (MC used now) Example of 1500/1800 rule Example A: If a person's TDD is 30 units of Regular insulin, the insulin sensitivity factor would be 50 Take 1500 and divide by 30 So one unit of Regular insulin would be estimated to lower his blood glucose by 50 mg/dl Example B: If a person's TDD is 40 units of aspart, the insulin sensitivity factor would be 45 Take 1800 and divide by 40 One unit of aspart would reduce their blood sugar by 45 mg/dl applying correction factor Example: blood glucose 235 goal: 90-130 correction factor is 50 how many units of apart should he take? 235-100 = 135 Take 2 units insulin (50 each) avoid hypoglycemia!! -can dose in half units of insulin too example normally takes 2 units aspart breakfast bs is 305 how much apart should he take for breakfast? goal: 90-130 305-130= 175 (difference between goal and actual) 175/50 = 3.5 units (rounded down to 3 units for caution) will need 2 units (normal breakfast) plus 3 units to correct for high 67 yo male T2DM 30 yrs 1000 mg met Continue reading >>
Know Your Numbers. Diabetes Management At Mealtime
You do not want to be chasing glucose numbers to get them to target ranges on a daily basis. It is important to learn why the numbers are off so you can correct the problem. If you use insulin to control your blood glucose, whether you are type 1 or type 2, knowing your blood glucose readings before you eat can help you avoid being high or low in between meals or even throughout the day. Before any meal or large snack, it is important to test your blood glucose to determine if your blood glucose level is high or low. Knowing your blood glucose level helps you determine if you need extra insulin or perhaps less insulin with your mealtime insulin dose. This adjustment is called your correction factor or dose adjustment. Do you know why you need to do this or how? Why you need to know If you give yourself only enough insulin to cover your meal, that's all it covers. If you are high before a meal, you will still be high after your meal because you only covered your meal glucose. If you were low before, you will still be low. How do you know? So how do you know if you are high or low with your pre meal glucose readings? The American Diabetes Association has set a blood glucose range of 70 to 130 mg/dl. The American Association of Clinical Endocrinologists indicates a level of less than 110 mg/dl. Your physician should provide you with a specific number that best fits your individual needs. If your pre- meal glucose reading is low (below 70 mg/dl or the value that your doctor has indicated is low for you), you may need to subtract one or two units from your mealtime insulin so you don't go too low. Conversely, if your glucose is high (above 180 mg/dl or the level your doctor determined is high for you), you may need to add one or two units to your mealtime insulin in order to Continue reading >>
Interactive Diabetes Case 9: Management Of Type 1 Diabetes In A Patient On Glucocorticoid Therapy - A2
ANSWER Correct. The patient and allergist report that the patient requires systemic steroids for several months each year during the allergy season and will be on prednisone for the next three to four months, probably at a dose of 20 to 30 mg a day in the morning. The management of glucocorticoid-induced hyperglycemia depends, in part, on the anticipated duration of glucocorticoid therapy. If the anticipated course is brief (as an example, one to two weeks), it may be sufficient to increase the doses of short-acting or very-short-acting insulin and to avoid a change in the dose of the basal (intermediate or long-acting) insulin, the effect of which will be difficult or impossible to assess when the insulin requirement is falling as the steroid is tapered. If the anticipated dose is longer, it is helpful to increase the basal insulin dose as well. What is your plan now? You increase the dose of NPH insulin to 20 units before breakfast and 10 units at bedtime. You add to the current doses of regular insulin before breakfast and supper an insulin correction factor before meals and at bedtime using a generous correction factor of 20, ie, 1 unit of short-acting (regular) insulin for every 20 mg/dL (1.1 mmol/L) elevation of the blood glucose level above a reference point of 120 mg/dL (6.7 mmol/L), approximately twice the correction factor one might otherwise use. (Based on the patient's insulin doses before the start of prednisone and using the rule of 1500, the correction factor would otherwise be 39.5.) An approach to estimating the dose of short- and very short-acting insulins is discussed separately (see "Interactive diabetes case 3: Hypoglycemia in a patient with type 1 diabetes - B2"). You anticipate further adjustment of the new insulin regimen as the patient monitors Continue reading >>
