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How To Calculate Insulin Dose According To Weight

Type 2 Diabetes: How To Calculate Insulin Doses

Type 2 Diabetes: How To Calculate Insulin Doses

Bolus Insulin Dose Carbohydrate Coverage Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on an individuals 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 Insulin Dose High Blood Sugar Correction Generally, to correct a high blood sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl. This drop in blood sugar can range from 15-100 mg/dl or more, depending on individual insulin sensitivities. Bear in mind, this may be too much insulin if you are newly diagnosed or still making a lot of insulin on your own. And it may be too little if you are very resistant to the action of insulin. Talk to your provider about the best insulin dose for you as this is a general formula and may not meet your individual needs. [First you will need to calculate your bodys total daily insulin requirement. About half that insulin will cover your basal needs:] The general calculation for the bodys daily insulin requirement is: Total Daily Insulin (TDI) Requirement (in units of insulin) = Weight in Pounds 4 Basal/background insulin dose = 50% of TDI. The UCSF Medical Center website has calculation examples and other information about insulin types and dosing schedules: 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 >>

Calculation Of The Initial Insulin Dosage

Calculation Of The Initial Insulin Dosage

The dose of Caninsulin and the interval between injections has to be tailored to suit each individual diabetic dog. Hypoglycemia Hypoglycemia is a major concern. To help avoid hypoglycemia: The dog's body weight should be rounded down to the nearest whole kilogram The calculated dose of insulin rounded down to the nearest whole or half unit This helps to avoid overdosing particularly during initial stabilization. Starting insulin dose for dogs In diabetic dogs the dose of Caninsulin can be given once daily or twice daily. After calculation of the starting insulin dose, subsequent adjustments to establish the maintenance dose may be required. For more information see product leaflet or dose adjustment. Once daily administration The once daily Caninsulin starting dose of 0.5 IU/kg (label may vary - for guidance see the product leaflet) was established and confirmed in dogs, based primarily on clinical response. Remember to round the dog’s bodyweight down to the nearest whole kilogram and the calculated dose down to the nearest whole or half unit. Twice daily administration Many specialists recommend that intermediate acting insulins be administered twice daily to dogs. Starting dose in the range of: 0.4-0.7 IU/kg twice daily is usually used, with larger bodyweight dogs started at the lower end of the range. (Ref: Broussard JD, Wallace, MS. Insulin treatment of diabetes mellitus in the dog and cat. In Kirk's Current Veterinary Therapy XII Small Animal Practice. Bonagura J ed. Saunders, Philadelphia, 1995. p. 393-8.) 0.25-0.5 IU/kg twice daily (Ref: Fleeman LM, Rand JS. (2001) Management of canine diabetes. Veterinary Clinics of North America: Small Animal Practice 31, 855-80.) The starting insulin dose range is thus taken as: 0.25-0.7 IU/kg twice daily - larger bodyweigh Continue reading >>

Calculating Insulin Dose

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 4-30 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 blood Continue reading >>

Insulin Dosing

Insulin Dosing

Two hour post-prandial Blood Glucose <160 mg/dl Aim for 50% of Blood Glucose s in target range Look for consistent pattern in Blood Sugar s for >3 days Compare Blood Sugar for same time each day Consider eating and activity patterns during day Maintain a 50:50 mix of Basal to Bolus Insulin Insulin dose 10-20 units: Adjust by 2 units Insulin dose >20 units: Adjust by 10% Insulin dose Decrease rapid Insulin ( Lispro ) at dinner One Unit covers each 10-15 grams carbohydrate Add 1-2 units for every 50 mg/dl Glucose >150 Indications to adjust basal Insulin (e.g. Glargine ) All Blood Glucose s high (within 50 mg/dl) Increase basal Insulin per adjustment above Critical to distinguish 3 AM low BG from high BG Indications to adjust Bolus Insulin (e.g. Lispro ) Two hour post-prandial >40-60 mg/dl over premeal Increase rapid acting Insulin before meal Average Insulin doses after titrating from start Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Insulin Dosing." 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 secrete Continue reading >>

Interactive Dosing Calculator

Interactive Dosing Calculator

Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>

Insulin Initiation Dose Calculator (type 2 Diabetes)

Insulin Initiation Dose Calculator (type 2 Diabetes)

Tweet This calculator helps people with diabetes to determine the correct initial insulin dose for type 2 diabetes patients. This calculator was invented in the UK Prospective Diabetes Study (Source: N England Journal of Medicine; 357: September 21). How to use the Insulin Initiation Dose Calculator To calculate the number of units required per day, simply input: Your weight Your height Your fasting blood glucose Your gender You will then be presented with the initial dose in IU/day. This tool is meant for indicative purposes only. Please consult your GP or healthcare team to determine your insulin initiation dose. Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary sugar. The good news is for very many people with type 2 diabetes this is all they have to do to stay well. If you can keep your blood sugar lower by avoiding dietary sugar, likely you will never need long-term medication. Type 2 diabetes was formerly known as non-insulin-dependent or adult-onset diabetes due to its occurrence mainly in people over 40. However, type 2 diabetes is now becoming more common in young adults, teens and children and accounts for roughly 90% of all diabetes cases worldwi 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 >>

Smartphone Apps For Calculating Insulin Dose: A Systematic Assessment

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 >>

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 >>

Weight-based Insulin Dosing Safe At Recommended Doses

Weight-based Insulin Dosing Safe At Recommended Doses

Weight-based insulin doses up to 0.6 units per kilogram are associated with a low risk of hypoglycemia, according to a new report…. Dr. Daniel J. Rubin from Temple University School of Medicine in Philadelphia writes that, "Our study provides evidence for the safety of daily insulin doses up to 0.6 units/kg." "I hope this will encourage more physicians to be comfortable using weight-based insulin dosing." Dr. Rubin and colleagues investigated the relationship between insulin dose and hypoglycemia in a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. The report appears online June 23 in Diabetes Care. The unadjusted odds of hypoglycemia increased with insulin doses above 0.2 units/kg, and patients who received insulin doses of 0.6 units/kg or more faced increased odds of hypoglycemia. The adjusted odds of hypoglycemia were not higher among patients who received 0.2 to 0.6 units/kg. The adjusted odds of hypoglycemia were 3 times higher among patients who didn’t receive sliding scale insulin than among those who did, and there was a trend toward higher odds among patients who received NPH compared with patients who received glargine or short-acting insulin. Hypoglycemia was not more common among patients given insulin with an oral diabetes medication than among those given insulin alone. "0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low," the researchers note. "Some patients, however, require more than 0.6 units/kg to treat hyperglycemia and do not experience any hypoglycemia," Dr. Rubin said. "If there is any concern for hypoglycemia, it is reasonable to use doses <0.6 unit/kg. Insulin dosing for individual patients must be done on a case-by-case basis." "Our data are consistent with t Continue reading >>

Insulin Doses And Body Weight

Insulin Doses And Body Weight

Thanks to Ken S, I recently read about insulin and the problems it causes if taken in high doses. The recommended "safe" dose was 0.5 units to each kg of body weight. Up until recently I had been taking at least 3 times that, and health problems have become rather serious of late. About 3 weeks ago I got the flu and during that time was able to change my diet and reduce my insulin intake by about a third. The result was a weight loss of 8 kgs in a very short time. Today I talked to my doctor about this. She agreed about the 0.5 units of insulin per kg of body weight (I wonder how many of her patients know that?) and that the insulin reduction has enabled me to lose some weight. But this leads me now to more questions. Take tonight. I have already had 65 units of insulin throughout the day, and am due for another 25 of Lantus before bed. My bg is reading at 9.2 and I would usually take another 5 units of NovaRapid for that. But which is safer? To leave it at 9.2 and hope it will drop overnight? Or to take the excess insulin and go by the numbers? I have already noticed that the more insulin I have, the more likely I am to have an attack of arterial filbrillation and angina. But that also means that the higher my bgs are, the more likely I am to have an attack. I am very confused. In order to become what you are to be, you must learn, first, to be what you are. D.D. Family T1 since 1977 - using Novolog in an Animas pump. You need to take as much insulin as you need to maintain satisfactory blood glucose numbers. Doctors will tell you that keeping blood glucose down is more important than reducing the daily insulin dose. How much insulin you need to achieve acceptable numbers depends partly on what you eat. Reducing carbohydrate reduces insulin requirement. It is the easi Continue reading >>

Weight-based, Insulin Dose–related Hypoglycemia In Hospitalized Patients With Diabetes

Weight-based, Insulin Dose–related Hypoglycemia In Hospitalized Patients With Diabetes

Go to: Abstract To determine the association of weight-based insulin dose with hypoglycemia in noncritically ill inpatients with diabetes. We performed a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. Patients with glucose levels <70 mg/dL (case subjects) were matched one to one with nonhypoglycemic control subjects on the basis of the hospital day of hypoglycemia, age, sex, and BMI. RESULTS Relative to 24-h insulin doses <0.2 units/kg, the unadjusted odds of hypoglycemia increased with increasing insulin dose. Adjusted for insulin type, sliding-scale insulin use, and albumin, creatinine, and hematocrit levels, the higher odds of hypoglycemia with increasing insulin doses remained (0.6–0.8 units/kg: odds ratio 2.10 [95% CI 1.08–4.09], P = 0.028; >0.8 units/kg: 2.95 [1.54–5.65], P = 0.001). The adjusted odds of hypoglycemia were not greater in patients who received 0.2–0.4 units/kg (1.08 [0.64–1.81], P = 0.78) or 0.4–0.6 units/kg (1.60 [0.90–2.86], P = 0.11). Although the relationship between insulin dose and hypoglycemia did not vary by insulin type, patients who received NPH trended toward greater odds of hypoglycemia compared with those given other insulins. Higher weight-based insulin doses are associated with greater odds of hypoglycemia independent of insulin type. However, 0.6 units/kg seems to be a threshold below which the odds of hypoglycemia are relatively low. These findings may help clinicians use insulin more safely. Predictors of hypoglycemia in the multivariate conditional logistic regression model Odds ratio (95% CI) P Insulin dose 0.005 0.2–0.4 vs. <0.2 1.08 (0.64–1.82) 0.777 0.4–0.6 vs. <0.2 1.60 (0.90–2.86) 0.109 0.6–0.8 vs. <0.2 2.10 (1.08–4.09) 0.028 >0.8 vs. <0.2 2.95 (1.54–5.65) Continue reading >>

Mealtime Dosage Calculator

Mealtime Dosage Calculator

The mealtime dosage calculator is intended as an aid in figuring mealtime rapid-acting insulin requirements. It should only be used under the supervision and guidance of your health care team. Mealtime Dosage Calculator Instructions **IMPORTANT!!! Do not use the Mealtime Dosage Calculator without first discussing your exact insulin requirements with the clinician who prescribes your insulin. All values entered into the calculator should be determined with the guidance of your health care team. note: the Mealtime Dosage Calculator will work on most major spreadsheet programs, including Excel. To Use The Mealtime Insulin Dose Calculator: 1. You will need to enter your insulin dosage formulas into the boxes in the top left. Information can only be entered in the YELLOW boxes. First, enter the meal/situation that the chart applies to. For example, “breakfast” or “lunch before exercise” or “all meals”. Second, enter your target blood glucose (your “ideal value”). This should be one exact number in mg/dl, such as “100” or “120”. Third, enter your sensitivity factor. This is the amount that one unit of insulin lowers your blood glucose. Fourth, enter your carb:insulin ratio. This is the grams of carbohydrate “covered” by one unit of insulin. Fifth, enter an exercise factor (if needed). An exercise factor of 1.00 means that you will not be exercising and want to take your usual dose. If you want to lower your doses by 25% in anticipation of exercise, enter “.75”. If you want to lower your doses by 33%, enter “.67”. If you want to take half of your usual doses, enter “.50”. 2. The numbers on the large chart will update to reflect your mealtime insulin doses based on the parameters entered above. Find the grams of carbohydrate in the top ro Continue reading >>

Insulin Dosing

Insulin Dosing

OTHER HELPFUL PAGES ACRONYMS AND DEFINITIONS ADA - American Diabetes Association Basal Insulin - Long- and Intermediate-acting insulins used to supply constant blood levels of insulin activity Carb- carbohydrate DM1 - Type 1 diabetes DM2 - Type 2 diabetes FDA - U.S. Food and Drug Administration Hypoglycemia - low blood sugar Multidose insulin regimen - Insulin regimens that involve a basal insulin and a premeal insulin given at meals Premeal Insulin - also called “prandial” insulin. Rapid and short-acting insulins given at mealtime for short burst of insulin. Total daily dose of insulin - Sum of premeal and basal insulin given in a day Units/kg/day - units of insulin per kilogram of body weight per day USDA - United States Department of Agriculture 1 kilogram = 2.2 pounds IMPORTANT POINTS ABOUT DOSING INSULIN Overview There are a number of different ways to dose insulin No detailed guidelines for dosing insulin have been issued by professional associations The appropriate method for individual patients will depend on a number of factors including patient education, patient motivation, diabetes control, and resources Low blood sugar (Hypoglycemia) The main concern in most patients when initiating an insulin regimen is the occurrence of low blood sugars Patients need to understand that when they are starting and adjusting insulin, there is an increased risk for low blood sugars A number of things can affect this risk including variations in eating patterns, sensitivity to insulin, and variations in activity level Measures to help prevent low blood sugars Start low and go slow - patients naïve to insulin should start at the lower end of dosing ranges When using a multidose regimen, adjust only one of the regimens every 3 days and alternate between the two (see below f Continue reading >>

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