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Insulin Correction Dose Table

Part Ii

Part Ii

Think Like a Pancreas Chapter 7, Your Cheat Guide! So, how sensitive are you? Does the Notebook make you cry? Do kittens make you warm inside? Just kidding. How sensitive to insulin are you? There are many variables that increase and decrease your sensitivity to you insulin, but when it comes to the basics, see below for the steps to determine how your body responds to your insulin dose: Test your blood sugar at least four hours after your most recent bolus. If your sugar is high, calculate and give yourself the correction dose. Go about your usual activities but do not eat or exercise for the next several hours. Test your sugars four hours later Calculate how much your blood sugar came down and then divide by the # of units you gave. This should come close to your sensitivity factor. Bolus Insulin On-Board. Other terminology: Bolus on board, active insulin, insulin remaining/actively working in your body. Quick fact: The fastest insulin takes about four hours to complete its job (sometimes even longer!) So what does one do when your experiencing a high blood sugar but still likely have insulin on-board? Aggressively treat? (Im)patiently wait for it to come down? Let’s find out. First, this concept of knowing how much active insulin is in your body is crucial because stacking leads to increased likelihood of low blood sugars. To get a visual idea of (estimated) insulin on board since your last bolus, check out Table 7-6. below: Example: Let’s say you injected 6 units of insulin for a 2PM snack and then check your blood sugar at 4pm. According to the table above, you still have 35% of your bolus remaining (6 units x .35 = 2 units). Considering this before your next bolus is important for proper dosing. Another way to determine how long it really takes for your bolus Continue reading >>

Fast-acting Insulin

Fast-acting Insulin

Even when you think you’re doing everything right with your diabetes care regimen, it can sometimes seem like your blood glucose levels are hard to control. One potential source of difficulty that you may not have thought of is how you time your injections or boluses of rapid-acting insulin with respect to meals. Since the first rapid-acting insulin, insulin lispro (brand name Humalog), came on the market in 1996, most diabetes experts have recommended taking it within 15 minutes of starting a meal (any time between 15 minutes before starting to eat to 15 minutes after starting to eat). This advice is based on the belief that rapid-acting insulin is absorbed quickly and begins lowering blood glucose quickly. However, several years of experience and observation suggest that this advice may not be ideal for everyone who uses rapid-acting insulin. As a result, the advice on when to take it needs updating. Insulin basics The goal of insulin therapy is to match the way that insulin is normally secreted in people without diabetes. Basal insulin. Small amounts of insulin are released by the pancreas 24 hours a day. On average, adults secrete about one unit of insulin per hour regardless of food intake. Bolus insulin. In response to food, larger amounts of insulin are secreted and released in two-phase boluses. The first phase starts within minutes of the first bite of food and lasts about 15 minutes. The second phase of insulin release is more gradual and occurs over the next hour and a half to three hours. The amount of insulin that is released matches the rise in blood glucose from the food that is eaten. In people with normal insulin secretion, insulin production and release is a finely tuned feedback system that maintains blood glucose between about 70 mg/dl and 140 mg/d Continue reading >>

About Fast-acting Mealtime Insulin

About Fast-acting Mealtime Insulin

What is mealtime insulin? Mealtime insulins are fast-acting insulins that are taken immediately before or after meals. As you eat, your blood sugar naturally goes up, or “spikes.” Humalog® (a fast-acting insulin) works to manage those blood sugar spikes and may help keep your sugar levels in balance. Humalog should be taken within 15 minutes before eating or right after eating a meal. People who take Humalog will usually continue to take longer-acting insulin to help manage blood sugar levels at night and between meals. Taking mealtime insulin in addition to longer-acting insulin may help to control blood sugar levels throughout the day. Low blood sugar (hypoglycemia) is the most common side effect of Humalog that may be severe and cause unconsciousness (passing out), seizures, and death. Test your blood sugar levels as your doctor instructs. Talk to your doctor about low blood sugar symptoms and treatment. The orange area shows how blood sugar levels typically rise after meals. The pattern of insulin action may vary in different individuals or within the same individual. Comparing types of insulin Take a look at our overview below to find out about the different types of insulin. You’ll notice that there are differences in when the types of insulin reach your bloodstream, when they “peak” in your body, and how long they can last (length of time the insulin keeps lowering your blood sugar). Fast-acting insulin (also called rapid-acting) is absorbed quickly and starts working in about 15 minutes to lower blood sugar after meals. Humalog fast-acting insulin should be taken 15 minutes before eating or right after eating a meal. Depending on the type of diabetes you have, you may need to take Humalog with a longer-acting insulin or oral anti-diabetes medication. 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 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 >>

Calculation Sheet For Rapid-acting Insulin With Ketone Bolus Correction

Calculation Sheet For Rapid-acting Insulin With Ketone Bolus Correction

Food Grams of Carbs Total Food Grams of Carbs Total Date _____________ Time ______________ am / pm 1. Calculate Carbohydrate Bolus: ____________ ÷ _______________ = ________________ Carbohydrates CARBOHYDRATE Carbohydrate Bolus to Eat RATIO (Round to nearest tenth) 2. Calculate Correction Bolus: __________ - ___________ = _________ ÷_____________= __________ Blood CORRECTION Amount to CORRECTION Correction Glucose TARGET Correct FACTOR Bolus (Round to nearest tenth) 3. Calculate Total Insulin Bolus: ___________ + __________ +___________ = _________ ____________ Carbohydrate Correction Ketone Bolus Total *Rounded Total Bolus Bolus (Use Ketone Insulin Bolus Bolus Chart) Date _____________ Time _______________ am / pm 1. Calculate Carbohydrate Bolus: ____________ ÷ _______________ = ________________ Carbohydrates CARBOHYDRATE Carbohydrate Bolus to Eat RATIO (Round to nearest tenth) 2. Calculate Correction Bolus: __________ - ___________ = _________ ÷_____________= __________ Blood CORRECTION Amount to CORRECTION Correction Glucose TARGET Correct FACTOR Bolus (Round to nearest tenth) 3. Calculate Total Insulin Bolus: ___________ + __________ +___________ = _________ ____________ Carbohydrate Correction Ketone Bolus Total *Rounded Total Bolus Bolus (Use Ketone Insulin Bolus Bolus Chart) “NO CORRECTION RULES†DO NOT CALCULATE CORRECTION BOLUS:  If your blood glucose is less than your CORRECTION TARGET.  If it has been less than three hours since your last carbohydrate bolus or correction bolus.  If you have treated a low blood glucose in the past three hours.  If it has been less than one hour since vigorous exercise. * Use this chart for “Rounded Total Insulin Bolus†CARBOHYDRATE RATIO How many grams of carbohydrate Continue reading >>

Insulin-to-carb Ratios Made Easy

Insulin-to-carb Ratios Made Easy

For those who take rapid-acting insulin at mealtimes and want any degree of meal planning flexibility, it is necessary to apply something known as insulin-to-carb (I:C) ratios. Now, if the mere thought of having to do math at every meal sends shivers up your spine, don’t despair. This is something that even the “mathematically challenged” can master in no time. The Method Behind the Mathematics One of the basic assumptions we make in the use of I:C ratios is that dietary carbohydrates, which include sugars, starches and fiber, are responsible for raising blood sugar levels after meals. Fiber, however, is usually not counted since it does not break down completely and does not raise blood sugar levels. And fat and protein have minimal short-term effects, particularly when consumed as part of a carbohydrate-containing meal. The rapid-acting insulin that we give at mealtimes is designed to offset the blood sugar rise induced by the carbohydrates. In most cases, insulin analogs such as aspart (Novolog/Novorapid), lispro (Humalog) or glulisine (Apidra) are used at meals. However, Regular insulin (Humulin R, Novolin R) may be used, but it tends to be less effective because of its slower action. Whichever insulin is used, success comes from matching the dose to the amounts of carbohydrate eaten. This is where I:C ratios come in. The I:C ratio specifies how many grams of carbohydrate are “covered” by each unit of insulin. For example, a 1-unit-per-10-grams-of-carb (1:10) ratio means that one unit of insulin covers 10 grams of carbohydrate. A 1:20 ratio means that each unit covers 20 grams. Calculating a meal or snack dose becomes simple when you know your I:C ratio: Simply divide your carbs by your ratio. If each unit covers 10g and you have a modest 20g meal, you wil Continue reading >>

Understanding Advanced Carbohydrate Counting — A Useful Tool For Some Patients To Improve Blood Glucose Control

Understanding Advanced Carbohydrate Counting — A Useful Tool For Some Patients To Improve Blood Glucose Control

Today’s Dietitian Vol. 15 No. 12 P. 40 Suggested CDR Learning Codes: 2070, 3020, 5190, 5460; Level 3 Take this course and earn 2 CEUs on our Continuing Education Learning Library Click here for patient handout Carbohydrate, whether from sugars or starches, has the greatest impact on postprandial blood sugar levels compared with protein and fat. For this reason, carbohydrate counting has become a mainstay in diabetes management and education. Patients with type 1 or 2 diabetes benefit from carbohydrate counting in terms of improvements in average glucose levels,1,2 quality of life,2,3 and treatment satisfaction.3 Basic carbohydrate counting is used to keep blood glucose levels consistent, while advanced carbohydrate counting helps with calculating insulin dose. Both basic and advanced carbohydrate counting give people with diabetes the freedom to choose the foods they enjoy while keeping their postprandial blood glucose under control. This continuing education course introduces advanced carbohydrate counting as a tool for improving blood glucose management, evaluates basic and advanced carbohydrate counting, describes good candidates for advanced carbohydrate counting, and discusses strategies for counseling patients as well as precautions when using advanced carbohydrate counting. Basic Carb Counting Basic carbohydrate counting is a structured approach that emphasizes consistency in the timing and amount of carbohydrate consumed. Dietitians teach patients about the relationship among food, diabetes medications, physical activity, and blood glucose levels.4 Basic carbohydrate counting assigns a fixed amount of carbohydrate to be consumed at each meal and, if desired, snacks. Among the skills RDs teach patients are how to identify carbohydrate foods, recognize serving s Continue reading >>

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic Control In Hospitalized Patients Not In Intensive Care: Beyond Sliding-scale Insulin

Glycemic control in hospitalized patients who are not in intensive care remains unsatisfactory. Despite persistent expert recommendations urging its abandonment, the use of sliding-scale insulin remains pervasive in U.S. hospitals. Evidence for the effectiveness of sliding-scale insulin is lacking after more than 40 years of use. New physiologic subcutaneous insulin protocols use basal, nutritional, and correctional insulin. The initial total daily dose of subcutaneous insulin is calculated using a factor of 0.3 to 0.6 units per kg body weight, with one half given as long-acting insulin (the basal insulin dose), and the other one half divided daily over three meals as short-acting insulin doses (nutritional insulin doses). A correctional insulin dose provides a final insulin adjustment based on the preprandial glucose value. This correctional dose resembles a sliding scale, but is only a small fine-tuning of therapy, as opposed to traditional sliding-scale insulin alone. Insulin sensitivity, nutritional intake, and total daily dosing review can alter the physiologic insulin-dosing schedule. Prospective trials have demonstrated reductions in hyperglycemic measurements, hypoglycemia, and adjusted hospital length of stay when physiologic subcutaneous insulin protocols are used. Transitions in care require special considerations and attention to glycemic control medications. Changing the sliding-scale insulin culture requires a multidisciplinary effort to improve patient safety and outcomes. In the United States, the prevalence of diabetes mellitus is now 10.8 percent of adults 20 years and older, and 23.1 percent of adults 60 years and older.1 An estimated one in five U.S. health care dollars is spent caring for someone with diabetes.2 Over the past 10 years, the Agency fo 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 >>

Getting Started With Insulin

Getting Started With Insulin

If you have been talking about getting started on insulin with your doctor, or if taking insulin is new to you, you may have questions or concerns. The following guide will help you understand the types of insulin, options for taking insulin, how and where to inject insulin, and insulin care and storage. Insulin pens Your pen comes with an instruction book. Please review it to understand how your pen works, how to load the cartridge and how to prepare your pen for an insulin injection. Mixing insulin Insulin that is cloudy (NPH, premixed) needs to be mixed before using. The pen should be rolled ten times, tipped ten times and checked for a milky-white consistency. Check insulin flow (prime) Attach pen needle. Dial up two units and, with pen tip facing upwards, push the dosing button. If no stream of insulin appears, repeat with another two units. Giving your injection After you have checked the insulin flow, dial up the dose of insulin to be taken. Insert pen tip into skin at a 90º angle. Push the dosing button until you see ‘0’. Count 10 seconds before removing the needle from your skin to ensure you receive the full dose. With longer needles (≥ 8mm), you may need to gently lift the skin before injection. Insulin injection sites Site Pros Cons Abdomen (tummy) Stay 2 inches (5 cm) away from your belly button Easy to reach; insulin absorbs fast and consistently None Buttock and thigh Slower absorption rate than from abdomen and arm sites Slower absorption; absorption can be affected by exercise Outer arm After abdomen, arm provides the next fastest absorption rate Harder to reach for self-injections NOTE: It is really important to change (rotate) where you give yourself insulin to prevent fatty lumps from forming since these can affect how your body absorbs insuli Continue reading >>

School Medical Management Plan For Student With Diabetes

School Medical Management Plan For Student With Diabetes

Name: ______________________________________________________________ Address: _____________________________________________________________ Phone: __________________________ Fax:_______________________________ Answering Service: ________________ Student Name: ________________________________ DOB:____________ Grade:___________ Physical Condition: FORMCHECKBOX Diabetes type 1 FORMCHECKBOX Diabetes type 2 Date of diagnosis:_____________ Mother/Guardian: ________________Telephone: Home_____________ Work/Cell________________ Father/Guardian: ________________Telephone: Home ____________ Work/Cell_______________ Other Emergency Contact: Name: ____________Relationship: ___________Telephone____________ Times to check blood glucose: Before Breakfast Before PE Symptoms of hyperglycemia Before Lunch Before dismissal Symptoms of hypoglycemia Other __________________________________________ Student’s self-care blood glucose monitoring skills: Independently checks own blood glucose May check blood glucose with supervision Requires school nurse or trained diabetes personnel to check blood glucose Exception: may need help if blood glucose is low · If child’s blood glucose is low ________ mg/dL, see low blood sugar quick reference. · If child’s blood glucose is high _______ mg/dl, before eating or if sick or vomiting, CHECK URINE FOR KETONES. Never send a child home for high blood glucose unless ketones are moderate or large or child is vomiting or feels ill. See high blood sugar quick reference. · Testing should be done in the classroom. If this is not possible, the student must be accompanied by a responsible person to the location designated by the school. *There is no need to check blood glucose after snack or meal unless the child feels like he/she is h Continue reading >>

Type 2 Diabetes And Insulin

Type 2 Diabetes And Insulin

Getting Started When most people find out they have Type 2 diabetes, they are first instructed to make changes in their diet and lifestyle. These changes, which are likely to include routine exercise, more nutritious food choices, and often a lower calorie intake, are crucial to managing diabetes and may successfully lower blood glucose levels to an acceptable level. If they do not, a drug such as glyburide, glipizide, or metformin is often prescribed. But lifestyle changes and oral drugs for Type 2 diabetes are unlikely to be permanent solutions. This is because over time, the pancreas tends to produce less and less insulin until eventually it cannot meet the body’s needs. Ultimately, insulin (injected or infused) is the most effective treatment for Type 2 diabetes. There are many barriers to starting insulin therapy: Often they are psychological; sometimes they are physical or financial. But if insulin is begun early enough and is used appropriately, people who use it have a marked decrease in complications related to diabetes such as retinopathy (a diabetic eye disease), nephropathy (diabetic kidney disease), and neuropathy (nerve damage). The need for insulin should not be viewed as a personal failure, but rather as a largely inevitable part of the treatment of Type 2 diabetes. This article offers some practical guidance on starting insulin for people with Type 2 diabetes. When to start insulin Insulin is usually started when oral medicines (usually no more than two) and lifestyle changes (which should be maintained for life even if oral pills or insulin are later prescribed) have failed to lower a person’s HbA1c level to less than 7%. (HbA1c stands for glycosylated hemoglobin and is a measure of blood glucose control.) However, a recent consensus statement from Continue reading >>

What Is A Correction Dose Of Insulin For Diabetes Treatment?

What Is A Correction Dose Of Insulin For Diabetes Treatment?

If you have diabetes and your blood glucose is too high, you may need to add extra short-acting insulin to "correct" your high blood glucose. Correction doses are usually given as needed at meal times and bedtime, and shouldn't be given more often than every three to four hours. Your doctor may give you this information as part of your insulin regimen. Continue reading >>

Smartphone Apps For Calculating Insulin Dose: A Systematic Assessment

Smartphone Apps For Calculating Insulin Dose: A Systematic Assessment

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. 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. The majority of insulin dose calculator apps provide no prote Continue reading >>

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