diabetestalk.net

# Calculating Insulin Dose Type 1 Diabetes

## 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 >>

## “calculating Insulin Dose” In Type 1 Diabetes From Diabetes Education Online

Your doctor will prescribe an insulin dosing regimen for you to get you started on your type 1 diabetes that will include the three components of intensive insulin therapy: Basal Insulin Dosage – a once or twice daily dose of long acting insulin [glargine or detemir] Bolus Dosage – a short acting insulin dosage based on the amount of the carbohydrates in each meal [aspart, glulisine, or lispro] (To learn how to determine the amount of carbohydrates in each meal see Counting Carbohydrates from Diabetes Education Online). Bolus Correction Dose For A High Blood Sugar – a correction factor dosage to bring your blood sugar level back to the target range when it gets too high (out of the target range) [aspart, glulisine, or lispro]. However, each of these three dosages can change over time or even throughout the day and you will learn how to adjust up or down each of these three components. Of course, your diabetes team should always be available by phone or internet to counsel you on an appropriate insulin dosage for any of the three components of intensive insulin therapy if you’re unsure. What follows are the first three examples* from “Calculating Insulin Dosage” from Diabetes Education Online which will show you how you will do it: *Example #4, “Formulas commonly used to create insulin dose recommendations” is in the next post of my blog study notes (and, of course, on the “Calculating Insulin Dosage” page from Diabetes Education Online). First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-6 Continue reading >>

## Howard Wolpert Md Vp For Medical Innovation

Lilly Innovation Center, Cambridge MA Insulin Dosing for Fat and Protein in Type 1 Diabetes Disclosure No relevant Conflict of Interest Carbohydrate to Insulin Ratio, circa 1935 Carbohydrate quantity Insulin-to-Carb ratio Insulin doseX = This dosing formula - which is incorporated in current insulin bolus calculators - has never been scientifically validated Does this approach work in practice? The Current Approach: Food Insulin Dose Calculation Carbohydrate quantity Insulin-to-Carb ratio Insulin doseX = Assumes that accuracy in carb counting is a feasible goal for most patients Assumes that carbs are the only dietary ingredient that affects insulin requirements Assumptions and Limitationsâ€¦. Is this a realistic goal? Is there any scientific validity to carb-based insulin dosing? The Current Approach: Food Insulin Dose Calculation 8/7/2017 2 Carbohydrate Counting (In)accuracy Company Confidential Â© 2017 Eli Lilly and Company 7 Patient estimated quantity (grams) HbA1c 30 grams 300 200 100 0 Insulin Pharmacodynamics Aspart Lispro Steak & fries Free fatty acids induce insulin resistance Does dietary fat increase insulin requirements? Plasma FFA (mmol/L) Glucose infusion rate (Âµmol/[kgÂ·min]) 0 60 120 180 240 300 360 Time (min) Roden, Price, Perseghin, Peterson, Rothman, Cline, Shulman. Mechanism of free fatty acid-induced insulin resistance in humans. J Clin Invest. 1996 ; 97: 2859 + p < 0.01 â€ p < 0.001 Free Fatty Acids induce Insulin Resistance Paracetamol/Acetaminophen absorbed in duodenum > Blood levels correlate with rate of gastric emptying Dietary Fat Delays Gastric Emptying and Glucose Absorption in T1D Adolescents Lodefalk, Aman, Bang. Effects of Fat Supplementation on Glycaemic Response and Gastric Empty ing in Adolescents with Type 1 Diabetes. D Continue reading >>

## New Online Calculator For The Diabetes Math Impaired

Those of us living with diabetes, especially type 1, feel like we're never-ending math story problems. How many units do you take if you want to eat X amount of carbs, at a current blood sugar of Y, with a sensitivity factor of Z that varies due to time of day, amount of sleep, any stress you may be experiencing, or which way the wind is blowing? We are walking D-Math calculators. Technology makes it easier, without a doubt. Insulin pumps automatically calculate boluses for meals and correcti ons, and many keep track of how much active insulin we have working at any given time. Apps can do some D-Math too, but the need to pull out your phone for every bolus is not for everyone. That's why it was exciting to hear about the new Diabetes Calculator for Kids, a new, online program that can do D-calculations for you. It's developed by Nationwide Children's Hospital in Columbus, OH. But don't be deceived by the names: this free resource can actually help any PWD, of any age. After my mom's recent ER and hospital experience that temporarily affected her D-Math ability in a big way, we turned to this online calculator tool to do the calculations for us. And it worked perfectly! The Diabetes Calculator is apparently the first of its kind -- which is somewhat amazing, because it's really nothing fancy beyond a web-based version of a programmable spreadsheet. The online tool can be personalized so that any PWD or caregiver can create an individualized, printable chart that displays the calculated bolus amounts for food or insulin corrections, in five easy steps. You just plug in your personal information including name and birth date, caregiver's name, and whether you want doses rounded to the nearest half or whole unit. Then you enter the carb-to-insulin ratio, sensitivity factor Continue reading >>

## Insulin Dosing In Type 1 Diabetes

Aka: Insulin Dosing in Type 1 Diabetes, Insulin Dosing in Type I Diabetes II. Dose: Initial Dosing with basal/Bolus Insulin Ketones moderate or less: 0.5 units/kg/day Divide total Insulin into basal and bolus dosing Basal Insulin (long-acting): 50% of total Insulin Regular Insulin may be used instead due to cost Adjust later for carb count variations at meals Example: 60 kg adult with moderate ketones Insulin Glargine ( Lantus ): 15 units at bedtime Insulin Lispro : 15 units total divided over meals III. Dose: Conversion from mixed Insulin (70/30 or 75/25) Hemoglobin A1C <9%: Decrease total Insulin by 20% Divide total Insulin into basal and bolus dosing Basal Insulin (long-acting): 50% of total Insulin Adjust later for carb count variations at meals See Insulin Dosing for adjustment regimen Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Insulin Dosing in Type 1 Diabetes." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism. protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the regulation of Continue reading >>

## 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 >>

## 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 >>

## A Review Of Insulin-dosing Formulas For Continuous Subcutaneous Insulin Infusion (csii) For Adults With Type 1 Diabetes

Go to: Continuous subcutaneous insulin infusion (CSII) is an intensive therapy typically reserved for motivated patients with type 1 diabetes (T1D) who have frequent hypoglycemia, a significant dawn phenomenon (excess hepatic glucose production and non-hepatic insulin resistance in the morning period) or widely fluctuating blood glucose when using multiple daily injections (MDIs) [1•]. If properly managed, CSII may provide patients with improved glucose control compared with MDI therapy [2, 3] and a lower incidence of severe hypoglycemia [4]. As noted in a recent review, the total number of insulin pump users worldwide is unknown but believed to vary greatly across countries [5]. Estimates suggest that there may be as many as 350,000–515,000 insulin pump users in the USA [1•, 6]. A large registry-based study of the more experienced endocrinology centers in the USA indicated that as many as 50 % of their patients with T1D used a pump [7]. Among European nations, in a 2010 report, the proportion of patients with T1D using CSII varies substantially, from ∼1 % in Russia and Portugal to about 20 % in Norway, Austria, the Netherlands, and Switzerland [8]. A 2011 publication estimated that about 10 % of Australian patients were using CSII, with an increasing number of patients initiating CSII sooner after diagnosis than in previous years [9]. Among Asian nations, the proportion of patients with T1D who are using CSII in Japan is estimated to be 7 % (author communication with Medtronic Japan). Precise insulin dosing during CSII is necessary to enable patients with diabetes to adhere to current treatment guidelines [10, 11]. Unfortunately, precise dosing is complicated by the need to calculate two to five different basal rates for a 24-h period to match varying insulin n Continue reading >>

## Calculating Insulin Dose

You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio. The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 6-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high bloo Continue reading >>

## Type 1 Diabetes Mellitus And The Use Of Flexible Insulin Regimens

The management of type 1 diabetes mellitus (formerly known as insulin-dependent diabetes) has changed dramatically over the past 30 years. In particular, new insulin strategies have improved the ability to maintain near-normal glycemia. Factors such as onset, peak and duration of action can influence the ability of a particular insulin regimen to help control glucose levels. Patient factors, including individual variations in insulin absorption, levels of exercise and types of meals consumed, also influence the effectiveness of an insulin regimen. Rapid-acting insulin lispro is an ideal mealtime insulin. The premeal dose of insulin lispro can be adjusted based on the content of the meal and the patient's blood glucose level. Intermediate-acting and long-acting insulins should not be given to account for the content of a specific meal. Long-acting insulin can be administered once daily at bedtime or, ideally, twice daily in addition to another type of insulin. Patients with type 1 diabetes typically require an insulin dosage of 0.5 to 1.0 unit per kg per day. Newly diagnosed patients may have lower initial requirements because of continued endogenous insulin production. Flexible insulin regimens are based on predetermined actions in response to self-monitoring of blood glucose levels and carbohydrate intake. Pharmacology of Insulin Several important factors affect the absorption of subcutaneously administered insulin and explain much of the unstable glycemia that occurs in patients with type 1 diabetes. The time it takes to absorb one half of an injected dose of insulin may vary by 25 to 50 percent among individual patients.5 For example, NPH insulin may have a duration of activity of 18 hours in one patient but an effective activity of only 9 or 10 hours in another pati Continue reading >>

## Smartphone Apps For Calculating Insulin Dose: A Systematic Assessment

Go to: Abstract Medical apps are widely available, increasingly used by patients and clinicians, and are being actively promoted for use in routine care. However, there is little systematic evidence exploring possible risks associated with apps intended for patient use. Because self-medication errors are a recognized source of avoidable harm, apps that affect medication use, such as dose calculators, deserve particular scrutiny. We explored the accuracy and clinical suitability of apps for calculating medication doses, focusing on insulin calculators for patients with diabetes as a representative use for a prevalent long-term condition. We performed a systematic assessment of all English-language rapid/short-acting insulin dose calculators available for iOS and Android. Results Searches identified 46 calculators that performed simple mathematical operations using planned carbohydrate intake and measured blood glucose. While 59% (n = 27/46) of apps included a clinical disclaimer, only 30% (n = 14/46) documented the calculation formula. 91% (n = 42/46) lacked numeric input validation, 59% (n = 27/46) allowed calculation when one or more values were missing, 48% (n = 22/46) used ambiguous terminology, 9% (n = 4/46) did not use adequate numeric precision and 4% (n = 2/46) did not store parameters faithfully. 67% (n = 31/46) of apps carried a risk of inappropriate output dose recommendation that either violated basic clinical assumptions (48%, n = 22/46) or did not match a stated formula (14%, n = 3/21) or correctly update in response to changing user inputs (37%, n = 17/46). Only one app, for iOS, was issue-free according to our criteria. No significant differences were observed in issue prevalence by payment model or platform. Conclusions The majority of insulin dose calcu Continue reading >>