diabetestalk.net

Basal Bolus Insulin Calculator

Blood Glucose Monitoring: Use Of Automated Bolus Calculators For Diabetes Management

Blood Glucose Monitoring: Use Of Automated Bolus Calculators For Diabetes Management

Automated Bolus Calculators Insulin dosing algorithms have been used for years by healthcare providers to improve glucose control in patients with diabetes. With the development of insulin pumps and their increased use in the early 1980s, and with the publication of the results from the Diabetes Control and Complications Trial (DCCT) in the early 1990s demonstrating the benefits of intensive glucose control in preventing the long-term complications of diabetes, both the capacity and need to achieve intensive glucose control occurred.1–4 The first technology to assist patients in calculating meal insulin boluses, which was developed to improve post-prandial glucose control, was in a personal digital assistant (PDA), reported by Gross et al.5 in 2003. This became the prototype for the meal ‘bolus wizard’ developed by Medtronic MiniMed (Northridge, CA) for use in their insulin pumps. Currently, all commercially available insulin pumps have some form of automated bolus calculator (ABC) algorithm software built into them, although the parameters for each ABC vary.6 Over the last few years, glucose meters have begun incorporating ABCs (e.g. ACCU-CHEK® Aviva Expert® and FreeStyle InsuLinx® Blood Glucose Monitoring System) to assist with pre-meal insulin dosing for patients using basal/bolus insulin regimens other than pumps (insulin syringes, pens or spring-loaded insulin delivery devices such as the V-Go®). With the increasing use of smart phone technology to support diabetes self-management it is only a matter of time before applications with ABCs are incorporated into them.7 This paper reviews the current use of ABCs to calculate insulin dosages and discusses the potential future software innovations which could hopefully help healthcare providers and their patien Continue reading >>

Insulin Dose Calculator

Insulin Dose Calculator

This insulin dose calculator helps people with type 1 diabetes to determine the total daily dose of insulin, basal & bolus insulin, insulin to carb ratio, carb insulin dose, insulin sensitivity factor, BS correction insulin, and total meal-time bolus-insulin. Insulin calculator for type 1 diabetes To calculate the type 1 diabetes insulin requirement, you need to input certain details such as: Enter your body weight, select unit (pounds or kilogram), click "calculate total insulin" to get total, basal & bolus insulin and proceed further by pressing Next (insulin to the carb ratio). You do not require to note down the value, because finally, you will be presented with all the values. Select your bolus insulin type (regular or Humalog & Novolog), click "calculate ICR & BSCF" to get insulin to carb ratio & insulin sensitivity factor, and proceed further by pressing Next (BS correction insulin). Enter your present BS & target BS, select the unit (mmol/l or mg/dl), click "calculate BS correction" to get BS correction insulin and proceed further by pressing Next (total meal time insulin). Enter grams of carbohydrate in your meal, click "calculate meal bolus insulin" to get the insulin dose to cover meal time carbohydrate and total meal-time bolus-insulin and proceed further by pressing Next (consolidated result). Here you are presented with all the details of your insulin treatment dosages. Thanks for using our insulin calculator. The insulin dosage provided by this calculator is for your reference purpose only, you need to consult with your doctor before start taking the suggested insulin dosage. You need to adjust your daily dose of insulin Insulin dose adjustment has based on the TDD (total daily dose of insulin) you received in the preceding 24 hours. If your BS at any tim Continue reading >>

Insulin Dosing And Outcomes Among Commercially Insured Patients With Type 2 Diabetes In The United States

Insulin Dosing And Outcomes Among Commercially Insured Patients With Type 2 Diabetes In The United States

Abstract The purpose of this study was to examine costs, resource use, adherence, and hypoglycemic events among patients with type 2 diabetes mellitus (T2DM) treated with increasing doses of 100-U/mL (U-100) insulin regimens. Data from Truven’s Health Analytics Commercial Claims and Encounters database from January 1, 2008, through January 31, 2011, were used. Regressions were used to examine the associations among costs, resource use, adherence, and receipt of a hypoglycemic event and index dose of insulin. Specifically, general linear models with a γ-distribution and log link were used to examine costs, whereas logistic and negative binomial regressions were used to examine resource use and hypoglycemic events. All analyses controlled for patient characteristics, preindex comorbidities, general health, use of antidiabetic medications, and visits to an endocrinologist. The study focused on 101,728 individuals with T2DM who received an outpatient prescription for U-100 insulin. In general, costs and resource use are highest among patients treated with the highest dose of insulin (>300 U/d). For example, all-cause and diabetes-related hospitalizations and office visits were highest in the highest-dose cohort. Costs generally followed the same pattern. Patients who were prescribed the lowest dose of insulin (10-100 U/d) generally had higher all-cause or diabetes-related inpatient and emergency department costs and resource use compared with those patients with an index dose >100 to 150, >150 to 200, and >200 to 300 U/d. There were generally no significant differences in rates of hypoglycemic events based on index dose. These results suggest significant differences in patient outcomes based on dosing of insulin. Those patients with T2DM using insulin at the highest and Continue reading >>

Tips For Calculating A Total Daily Dose Of Insulin

Tips For Calculating A Total Daily Dose Of Insulin

You can use one of several methods to determine a safe, initial dose Published in the August 2007 issue of Today’s Hospitalist. Evidence keeps mounting that high blood sugars lead to worse outcomes in hospitalized patients “and that sliding scale regimens produce both more hyperglycemia and hypoglycemia. But as hospitalists switch from sliding scale to basal and bolus dosing, how do they calculate a safe total daily dose to start with? Experts say that physicians can use any of three different strategies, depending on whether patients have been using insulin as either an outpatient or in the ICU. ~ Deepak Asudani, MD Baystate Medical Center Any one of these approaches will produce a safe, conservative initial dose, but experts warn that none of the strategies by itself is a slam dunk. You still have to bring art to each approach, adjusting doses according to such factors as illness severity and eating status. Related article: Keeping it simple with insulin regimens, July 2013 Here’s a look at how two hospitalists use these strategies in their day-to-day practice. 1. Base total sub-Q dose on insulin infusion rates. When Deepak Asudani, MD, a hospitalist at Baystate Medical Center in Springfield, Mass., transitions patients from IV insulin in the ICU to sub-Q insulin on the wards, he uses the following formula: Take the average hourly insulin infusion rate over the past six hours and multiply that rate by 20. That gives you a number that should equal 80% of the daily infusion dose. “It’s a little correction to prevent any hypoglycemia,” says Dr. Asudani. Because patients’ insulin needs are tapering down a bit as they exit the ICU, he adds, you don’t need to supply the same daily dose. For patients eating substantial amounts of food, you can use that calcul Continue reading >>

How To Calculate Insulin Dosing For Type 1 Diabetes (including Protein And Fibre)

How To Calculate Insulin Dosing For Type 1 Diabetes (including Protein And Fibre)

This article reviews a range of approaches to calculating insulin requirements for people with type 1 diabetes. The simplest approach is standard carbohydrate counting, which may be ideal for someone whose diet is dominated by carbohydrates. Bernstein recommends standardised meals for which the insulin dose is refined based on ongoing testing and refinement. Stephen Ponder’s ‘sugar surfing’ builds on carbohydrate counting, with correcting insulin given when blood glucose levels rise above a threshold due to gluconeogenesis. The food insulin index approach predicts insulin requirements based testing in healthy people of the insulin response to popular foods. The total available glucose (TAG) advocates a ‘dual wave bolus’ where insulin for the carbohydrates is given with the meal, with a second square wave bolus given for the protein which is typically slower to digest and metabolise. In the article Standing on the Shoulders of Giants, we met a handful of people who have achieved excellent blood sugar control in spite of having type 1 diabetes. Common elements of their success include: keeping carbohydrates low to prevent the blood sugar roller coaster, accurately dosing for a controlled amount of dietary carbohydrate, targeting normal blood sugar ranges (i.e. 83mg/dL or 4.6mmol/L) with regular correcting doses, regular exercise and / or intermittent fasting to improve insulin sensitivity, and having a reliable method to account for the insulinogenic effect of protein. Everyone’s diabetes management regimen is going to be different. There will be a degree of trial and error to find what will work best for you. This article reviews a number of approaches that you can learn from to see what suits you. In the 1970s Dr Richard Bernstein got hold of a blood glucose Continue reading >>

Managing Your Diabetes: Your Basal-bolus Insulin Plan

Managing Your Diabetes: Your Basal-bolus Insulin Plan

Keeping your blood glucose levels in check starts with your basal-bolus insulin plan. This plan consists of using short-acting insulin to prevent a rise in blood glucose after eating meals and a longer-acting insulin to keep blood glucose steady during periods of fasting, such as when you’re sleeping. This plan may require a number of injections throughout the day in order to mimic the way a non-diabetic person’s body receives insulin, unless you’re on pump therapy or using intermediate-acting insulin instead of long-acting insulin. Bolus insulin There are two types of bolus insulin: rapid-acting insulin and short-acting insulin. Rapid-acting insulin is taken at mealtimes and starts working in 15 minutes or less. It peaks in 30 minutes to 3 hours, and remains in the bloodstream for up to 3 to 5 hours. Short-acting or regular insulin is also taken at mealtimes, but it begins working about 30 minutes after the injection, peaks in 2 to 5 hours and stays in the bloodstream for up to 12 hours. Along with these two types of bolus insulin, if you’re on a flexible insulin schedule, you need to calculate how much bolus insulin you need. You’ll need insulin to cover carbohydrate intake as well as insulin to “correct” your blood sugar. People on a flexible dosing schedule use carbohydrate counting to determine how much insulin they need to cover the carbohydrate content of their meals. This means you would take a certain number of insulin units per a certain amount of carbohydrate. For example, if you need 1 unit of insulin to cover 15 grams of carbohydrate, then you would take 3 units of insulin when eating 45 grams of carbohydrate. Along with this insulin, you may need to add or subtract a “correction amount.” If your glucose level is a certain amount higher or Continue reading >>

Bolus Calculator: A Review Of Four “smart” Insulin Pumps

Bolus Calculator: A Review Of Four “smart” Insulin Pumps

Howard Zisser, M.D.Lauren Robinson, B.S.Wendy Bevier, Ph.D.Eyal Dassau, Ph.D.Christian Ellingsen, B.S.Francis J. Doyle III, Ph.D.Lois Jovanovic, M.D. The use of continuous subcutaneous insulin infusion (CSII) pumps has been gaining popularity since 1979, when the first research report on insulin pumps was published. Insulin pumps—small medical devices that are programmed to infuse insulin through a catheter placed under the skin—are a replacement for multiple daily injections of insulin. They are currently being used by 375,000 people with type 1 diabetes, many of whom prefer CSII to multiple daily injections because of the increased flexibility of diet and exercise, increased convenience and precision when dosing, and better predictability of blood glucose levels that insulin pumps can provide when used correctly. Recent pump manufacturers have engineered a new feature called a bolus calculator, which calculates bolus insulin doses based on input from the pump wearer, which functions to help patients obtain optimum control over blood glucose levels. The bolus calculator takes into account the patient's current blood glucose, target blood glucose, amount of carbohydrate consumed, and other factors such as insulin sensitivity and insulin-to-carbohydrate ratio as well as duration of insulin action (“insulin on board”). Each pump company calculates insulin doses in a slightly different way. This article will review differences in bolus calculator recommendations between four insulin pumps, as well as errors that may occur when using bolus calculators. It will also include an in silico simulation of a meal followed by a snack using multiple insulin decay curves. Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Insulin Regular Dosage

Insulin Regular Dosage

Applies to the following strengths: beef-pork 100 units/mL; pork 100 units/mL; human recombinant 100 units/mL; pork 500 units/mL; human recombinant 500 units/mL The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist. Usual Adult Dose for Diabetes Type 1 Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL (U-100) and 500 units of insulin per mL (U-500) Individualize dose based on metabolic needs and frequent monitoring of blood glucose -Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day -Most individuals with type 1 diabetes should be treated with multiple-daily insulin (MDI) injections or continuous subcutaneous insulin infusion (CSII) MDI Regimens: Utilizing a combination of prandial (i.e., bolus, rapid, or short-acting insulins) and basal (i.e., intermediate or long acting insulin) insulin, administer 3 to 4 injections per day; regular human insulin is a short-acting prandial insulin. --Administer U-100 insulin subcutaneously 3 or more times a day approximately 30 minutes prior to start of a meal --Administer U-500 insulin subcutaneously 2 to 3 times a day approximately 30 minutes prior to start of a meal CSII (Insulin Pump) Therapy: U-100 insulin only -Initial programming should be based on the total daily insulin dose of previous MDI regimen; check with pump labeling to ensure pump has been evaluated with the specific insulin to be used (e.g., Novolin(R) is not recommended for use in insulin pumps due to risk of precipitation). -While there is significant interpatient variability, approximately 50% of the total dose is provided as meal-related boluses and the remainder as a basal infusion. Intravenous Administration: U-100 insulin only; -Closely moni Continue reading >>

Bolus Calculators

Bolus Calculators

Go to: Carbohydrate Counting and Bolus Calculation One method for matching meal insulin to CHO intake is called ‘carbohydrate counting’ (CC).5 It is a systematic approach for insulin bolus size calculation, and in addition to improving metabolic control, CC has been shown to improve quality of life, treatment satisfaction, and psychological well-being and to increase dietary freedom without concomitant deteriorations in cardiovascular risk factors in patients with T1D.6,7 Insulin dose calculations by CC concern only bolus insulin, but a prerequisite for success is a correct basal insulin dose in the form of either long-acting insulin or a basal rate. Basal insulin dosing can be evaluated by diabetes diary review or basal rate check.8 The correction factor (CF) and the insulin to carbohydrate ratio (ICR), are patient specific empirically estimated parameters included in the insulin bolus calculation.8 CF is the decrease in BG level caused by 1 unit of subcutaneously injected rapid-acting insulin. ICR is the amount of CHO needed to match the BG lowering effect of 1 unit of rapid-acting insulin. Guides to CF and ICR estimations have been published.9,10 The clinician should however note that there is often a need for further parameter adaptation and that CF and ICR values may vary during the day. With basal insulin dosing, CF and ICR in place, the next step in the insulin bolus calculation procedure is to estimate the meal CHO content. To do this, knowledge about the CHO content of different foods is required. Furthermore, a BG measurement must be obtained and a BG target set. The BG target is patient specific depending on individual patient goals and may also vary according to time of day. Now the patient is ready to calculate an insulin bolus. The insulin bolus equati Continue reading >>

Insulin Regimens

Insulin Regimens

1. Monday, July 16, 2012 1 2. Objectives1. Discuss the different types of insulin preparations available to manage types 1 and 2 diabetes2. Review the various insulin protocols and address appropriate patient selection for each3. Address how to design and adjust insulin regimensMonday, July 16, 2012 2 3. What Type of Insulins Are Available?Monday, July 16, 2012 3 4. Normal Pancreas ‘Bolus’ Insulin (Meal Associated)Insulin Effect Basal Insulin (~0.5-1.0 U/hr.) Insulin is released in response to varying blood glucose levelsMonday, July 16, 2012 and hypoglycemia does not occur 4 5. Basal vs Bolus InsulinBASAL INSULIN BOLUS INSULIN• Suppress hepatic glucose • Meal-associated CHO production (overnight and disposal intermeal) • Storage of nutrients• Prevent catabolism (lipid • Help suppress inter-meal and protein) hepatic glucose – Ketosis production – Unregulated amino acid release• Reduce glucolipotoxicityMonday, July 16, 2012 5 6. Insulin Profiles Regular (6–10 hr) NPH (10–20 hr)Plasma Insulin Levels Ultralente (~16–20 hr ) 0 2 4 6 8 10 12 14 16 18 20 22 24 Monday, July 16, 2012 Time (hr) 6 Rosenstock J. Clin Cornerstone. 2001;4:50-61. 7. The Diffusion Of InsulinMonday, July 16, 2012 Holleman F. NEJM 1997;337(3):176-83 7 8. Insulin Self Association SitesMonday, July 16, 2012 8 9. Newer Insulins ONSET PEAK DURATION MODIFCATION (hr) (hr) (hr) LISPRO β-chain Pro →Lys28 0.25-0.5 1-2 3-5 (Humalog) β-chain Lys →Pro29 ASPART β-chain Pro →Asp28 0.25-0.5 1-2 2-4 (NovoLog) GLULISINE β-chain Lys → 3 Asn Similar Simil ar Similar (Apidra) β-chain Lys → 29 Glu GLARGINE β-chain Asp → 21Gly 1 None 24 (Lantus) β-chain Arg31 /Arg32 DETEMIR β-chain Lys29 (Nε- 2 6-8 18 (Levemir) tetradecanoyl)des( β- 30 ) thrMonday,NPH 2012 Native July 16, insul Continue reading >>

Transitioning Safely From Intravenous To Subcutaneous Insulin

Transitioning Safely From Intravenous To Subcutaneous Insulin

Current Diabetes Reports Authors Kathryn Evans Kreider, Lillian F. Lien Abstract The transition from intravenous (IV) to subcutaneous (SQ) insulin in the hospitalized patient with diabetes or hyperglycemia is a key step in patient care. This review article suggests a stepwise approach to the transition in order to promote safety and euglycemia. Important components of the transition include evaluating the patient and clinical situation for appropriateness, recognizing factors that influence a safe transition, calculation of proper SQ insulin doses, and deciding the appropriate type of SQ insulin. This article addresses other clinical situations including the management of patients previously on insulin pumps and recommendations for patients requiring glucocorticoids and enteral tube feedings. The use of institutional and computerized protocols is discussed. Further research is needed regarding the transition management of subgroups of patients such as those with type 1 diabetes and end-stage renal disease. Introduction Intravenous (IV) insulin is used in the hospitalized patient to control blood sugars for patients with and without diabetes who may exhibit uncontrolled hyperglycemia or for those who need close glycemic attention. Common hospital uses for IV insulin include the perioperative setting, during the use of high-risk medications (such as corticosteroids), or during crises such as diabetic ketoacidosis (DKA) [1,2]. Other conditions such as hyperglycemic hyperosmolar state (HHS) and trauma frequently require IV insulin, as well as specific hospital units such as the cardiothoracic intensive care unit [3,4]. The correlation between hyperglycemia and poor inpatient outcomes has been well described in the literature [5,6]. The treatment of hyperglycemia using an IV Continue reading >>

What Is An Insulin-to-carb Ratio?

What Is An Insulin-to-carb Ratio?

If you use fast-acting insulin and count carbohydrates, you want to know your insulin-to-carbohydrate ratio. An insulin-to-carb ratio allows you to easily figure out how much of your fast-acting insulin is needed for the amount of carbohydrate you consume. You can talk to your health care provider or certified diabetes educator (CDE) to help you know where to start and then through trial and error you can figure out the right ratio for you. An example of an insulin-to-carb ratio is 1:15 meaning one unit of insulin is needed for every 15 grams of carbohydrate. Someone needing more insulin may have a ratio of 1:10 and someone needing less insulin may have a ratio of 1:20. When you are trying to figure out your correct ratio, it is helpful to write down your blood sugar levels and check more frequently to see how the insulin-to-carb ratio you used affected your blood sugar levels two hours after eating. Calculating the best insulin-to-carb ratio is a process of trial and error: Check your blood sugar before eating and write down your result. Count your carbs and give your insulin and write down the insulin-to-carb ratio you are using. Check your blood sugar 2 hours after eating and write down your result. Try this process out a for a few days before adjusting your ratio. When you do adjust your ratio, do so in small, safe increments. When an insulin-to-carb ratio works consistently well, keep it! But remember that factors like illness, skipping a meal, extra exercise, stress and other changes in routine may cause your insulin-to-carb ratio to change. In the book Using Insulin, the authors share the Rule of 500 to figure out a good starting ratio. This applies to people with type 1 diabetes who are taking multiple daily injections of insulin. They write: Your body is often Continue reading >>

Mysugr Bolus Calculator – Get Help With Your Insulin Dose (currently Available In Eu)

Mysugr Bolus Calculator – Get Help With Your Insulin Dose (currently Available In Eu)

back to Overview It's time for lunch. Your blood sugar is 165 mg/dl (9.2 mmol/L). You have a big slice of pizza, a bag of chips, and a cold Diet Coke waiting for you. How much insulin do you take? I can think of a few ways this goes: There’s not much to think about. You always eat the same thing and always take the same amount of insulin. You define the phrase “creature of habit.” You hate thinking about all of this stuff, so you just guess. You love doing a bunch of math before every meal, so calculating your insulin dose is fun and easy. I can relate to the first two. There’s a lot of value in routine, and I’ve also done my share of guesstimating. That last one? Enjoying all of the diabetes math? I’m sorry. That’s just weird. (I’m teasing. Kind of…) But there’s another option, and it makes thinking about your insulin doses easier and more precise. I’m talking about a bolus calculator. If you wear an insulin pump, you’re probably already using one (they’re often built in). You’re welcome to stay and read, but there’s not much new information for you here. However, if you’re using injections (syringes or pens), like most people with diabetes, then stick around. This article should be helpful. So you don’t have (or want) an insulin pump, but I bet you have a smartphone. What does that mean? It means that you should meet mySugr’s Bolus Calculator. It’s a module integrated into the mySugr app that helps with your insulin doses (note: mySugr Bolus Calculator is currently approved for use in Europe). What the heck is a “bolus,” you ask? Great question. A bolus, in our case, is a single dose of insulin given all at once. In other words, it’s your mealtime shot or a shot to fix a high blood sugar. mySugr’s Bolus Calculator examines Continue reading >>

How To Manage Diabetes With Basal-bolus Insulin Therapy

How To Manage Diabetes With Basal-bolus Insulin Therapy

Diabetes is a disease that affects the way the body produces and uses insulin. Basal-bolus insulin therapy is a way of managing this condition. In type 1 diabetes, the production of insulin is affected. In type 2 diabetes, both the production and use of insulin are affected. In people without diabetes, insulin is produced by the pancreas to keep the body's blood sugar levels under control throughout the day. The pancreas produces enough insulin, whether the body is active, resting, eating, sick, or sleeping. This allows people without diabetes to eat food at any time of the day, without their blood sugar levels changing dramatically. For people with diabetes, this doesn't happen. However, a similar level of blood sugar control can be achieved by injecting insulin. Injections can be used throughout the day to mimic the two types of insulin: basal and bolus. People without diabetes produce these throughout the day and at mealtimes, respectively. What is a basal-bolus insulin regimen? A basal-bolus insulin regimen involves a person with diabetes taking both basal and bolus insulin throughout the day. It offers them a way to control their blood sugar levels. It helps achieve levels similar to a person without diabetes. Advantages There are several advantages to using a basal-bolus insulin regimen. These include: flexibility as to when to have meals control of blood sugar levels overnight they are helpful for people who do shift work they are helpful if travelling across different time zones Disadvantages The downsides to a basal-bolus regimen are that: people may need to take up to 4 injections a day adapting to this routine can be challenging it can be hard to remember to take the injections it can be hard to time the injections it's necessary to keep a supply of insulin w Continue reading >>

More in insulin