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Insulin Correction Dose Table

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 >>

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 >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

You’ve become the New York Times and the Wall Street Journal of medicine. A must-read every morning. ” Continue reading >>

Insulin Correction Dose Calculator -beta

Insulin Correction Dose Calculator -beta

perinatology.com Please enable JavaScript to view all features on this site. Insulin Correction Dose Calculator Select the type of insulin, enter the total daily dose of insulin used, the carbohydrate content of the meal, and press 'calculate' button to estimate the amount of insulin needed to cover the carbohydrate content of the meal. All calculations must be confirmed before use. The suggested results are not a substitute for clinical judgment. Neither Perinatology.com nor any other party involved in the preparation or publication of this site shall be liable for any special, consequential, or exemplary Insulin Type Rapid acting Insulin (Humalog, Novolog) Short acting (Regular) Total Daily Dose of Insulin (TDD) units Carbohydrate Content of meal : grams Current Blood Glucose mg/dL Target Pre-Meal Blood Glucose mg/dL Carbohydrate Ratio = One unit of insulin covers grams of carbohydrate Insulin Sensitivity Factor (ISF) = One unit insulin decreases blood glucose by mg/dL Insulin required to cover carbohydrate in meal units Correction to Dose Of Insulin units Dose Of Insulin for meal units Meal related insulin boluses are calculated according to the carbohydrate content of the meal using the carbohydrate-to-insulin ratio (CIR) The carbohydrate-to-insulin ratio (CIR) is the number of grams of carbohydrate that are covered by 1 unit of insulin. The CIR is calculated by dividing the constant 450 by the Total Daily Dose (TDD). The CIR may be different for different meals of the day. CIR-= 450 / TDD Example: TDD= 50 units insulin CIR= 450 /50 = 9 grams/unit The meal has 90 grams of carbohydrate Meal insulin bolus = carbohydrates/carbohydrate to insulin ratio CIR =90/9= 10 units If the post meal blood sugar is above the targeted blood sugar range for 2 to 3 days then consider 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 >>

Insulin (medication)

Insulin (medication)

"Insulin therapy" redirects here. For the psychiatric treatment, see Insulin shock therapy. Insulin is used as a medication to treat high blood sugar.[3] This includes in diabetes mellitus type 1, diabetes mellitus type 2, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states.[3] It is also used along with glucose to treat high blood potassium levels.[4] Typically it is given by injection under the skin, but some forms may also be used by injection into a vein or muscle.[3] The common side effect is low blood sugar.[3] Other side effects may include pain or skin changes at the sites of injection, low blood potassium, and allergic reactions.[3] Use during pregnancy is relatively safe for the baby.[3] Insulin can be made from the pancreas of pigs or cows.[5] Human versions can be made either by modifying pig versions or recombinant technology.[5] It comes in three main types short–acting (such as regular insulin), intermediate–acting (such as NPH insulin), and longer-acting (such as insulin glargine).[5] Insulin was first used as a medication in Canada by Charles Best and Frederick Banting in 1922.[6] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[7] The wholesale cost in the developing world is about US$2.39 to $10.61 per 1,000 iu of regular insulin and $2.23 to $10.35 per 1,000 iu of NPH insulin.[8][9] In the United Kingdom 1,000 iu of regular or NPH insulin costs the NHS 7.48 pounds, while this amount of insulin glargine costs 30.68 pounds.[5] Medical uses[edit] Giving insulin with an insulin pen. Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacid 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 >>

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 >>

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 >>

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 >>

How To Initiate And Dose

How To Initiate And Dose

The AACE Algorithm for Adding/Intensifying Insulin starts with the addition of a basal (long-acting) insulin. If glycemic control is not achieved,* treatment may be intensified with a prandial insulin.1 <7% for most patients with T2D; fasting and premeal BG <110 mg/dL; absence of hypoglycemia A1C and FBG targets may be adjusted based on patient's age, duration of diabetes, presence of comorbidities, diabetic complications, and hypoglycemia risk Adapted from AACE/ACE Consensus Statement1 Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection) Apidra® is a rapid-acting insulin analog indicated to improve glycemic control in adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes. When used as a mealtime insulin, the dose of Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra® given by subcutaneous injection should normally be used in regimens that include a longer-acting insulin. Important Safety Information for Apidra® (insulin glulisine [rDNA origin] injection) CONTRAINDICATIONS Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to Apidra® or any of its excipients. WARNINGS AND PRECAUTIONS Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Closely monitor blood glucose in all patients treated with insulin. Change insulin regimens 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. As with all insulin preparations, the time course of Apidra® action may vary by individual or at different times in 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 >>

Correction Factor

Correction Factor

The 1800 Rule For Determining Your Correction Factor When your blood sugar goes unexpectedly high, a correction bolus can be used to bring it down. To use the right correction bolus, you first determine your correction factor. The 1500 Rule for Regular was originally developed by Paul Davidson, M.D. in Atlanta, Georgia. Because the blood sugar tends to drop faster and farther on Humalog and Novolog insulins, we modified the 1500 Rule to an 1800 Rule for these insulins. (Some use a 2000 rule for these insulins.) The 1800 Rule shows how far your blood sugar is likely to drop per unit of Humalog and Novolog insulin. The 1500 Rule shows how far it will drop per unit of Regular. Numbers between 1600 and 2200 can be used to determine the correction factor. The number 1800 should work when the TDD is set correctly and the basal insulin makes up 50% of the TDD in someone with Type 1 diabetes. A number smaller than 1800 will work better when basal insulin doses make up less than 50% of the TDD, while a number higher than 1800 works better for those whose basal doses make up more than 50% of their TDD. Also recheck your TDD and basal percentage to make sure they are correctly set. Setting up your correction boluses can be done only after your basal doses have been tested for accuracy. If your basal doses are set too high, using a correction bolus may lead to lows, while basal doses that are too low will make it appear that correction boluses are not the right amount to bring high readings down as expected. The 1800 Rule: Works for Type 1 diabetes and most Type 2s Estimates the point drop in mg/dl per unit of Humalog or Novolog 1800/TDD = point drop per unit of Humalog (see Table) Example: Someone's Total Daily Dose of insulin = 30 units 1800/30 u/day = a 60 point drop per unit of Continue reading >>

How To Interpret Blood Glucose Monitoring Charts And Adjust Insulin Doses

How To Interpret Blood Glucose Monitoring Charts And Adjust Insulin Doses

Interpreting blood glucose results and being able to adjust insulin doses are useful skills for pharmacists to possess.The key to acquiring these skills is in understanding: The insulin regimen and the onset, peak and duration of action for the insulins used The glucose levels to aim for How to titrate insulin doses How all of the above relates to patients’ lifestyles and eating habits Understanding the regimen Insulin may be given alone or, for those with type 2 diabetes, with oral antidiabetic drugs (OADs), often metformin. Although this article focuses on adjusting insulin doses, readers should bear in mind that oral doses may also need to be adjusted. The three most commonly used insulin regimens are: Once daily intermediate-acting or long-acting insulin — normally given at bedtime or during the day, usually with an OAD Twice-daily pre-mixed insulin — one injection before breakfast, one before the evening meal (pre-mixed insulins contain fixed ratios of short- and long-acting insulins) Basal-bolus insulin — three daily injections of rapid- or short-acting insulin with meals and one or two injections of intermediate- or long-acting (basal) insulin The onset, peak and duration profiles of insulin products currentlyavailable in the UK are in the table. These should be used wheninterpreting a blood glucose result, to determine which insulin wasexerting its effect at the time of glucose measurement. Insulin preparations and their onset, peak and duration of action Preparation Onset (hr) Peak (hr) Duration (hr) Soluble insulin Human Actrapid 0.5 2–5 8 Humulin S 0.5 1–3 5–7 Hypurin Bovine Neutral 0.5/1 2–5 6–8 Apidra (Insulin glulisine) 0.25 1 3–4 Humalog (Insulin lispro) 0.25 1–1.5 2–5 Novorapid (Insulin aspart) 0.25 1–3 3–5 Hypurin Porcine Neu Continue reading >>

Sliding Scale Insulin Therapy: How It Works, Doses, Alternatives

Sliding Scale Insulin Therapy: How It Works, Doses, Alternatives

A healthy pancreas releases a burst of insulin as a person begins to eat. This prepares the body for the intake of glucose that is to come. For people who have type 1 diabetes or insulin-deficient type 2 diabetes, these bursts must be recreated through insulin injections either before or after a meal. The sliding scale is one way of working out how much insulin to take before each meal. Most doctors advise against the sliding scale approach. In fact, the American Diabetes Association have pushed for this treatment method to no longer be used. How the sliding scale works The "sliding scale" is actually a chart of insulin dosages. A doctor creates this chart based on how the patient's body responds to insulin, their daily activity, and an agreed-upon carbohydrate intake. As one moves along the chart, insulin dosage changes depending on two factors: Pre-meal blood glucose level This is usually plotted from low to high, down the chart's left-most column. As one slides from top to bottom, insulin dosage increases. This is because more insulin is needed to manage greater amounts of blood glucose. Mealtime This is usually plotted along the chart's top row. As one moves from breakfast to lunch to dinner within the same blood glucose level, dosage may vary. This is because insulin sensitivity, the way the body responds to insulin, can change throughout the day. The fat content of meals can also change through the day, and the doctor may have taken that into consideration. To work out the right dosage using a sliding scale, people should: test their blood glucose level find the matching blood glucose value along the chart's left-hand column slide horizontally along that value's row, until the current meal is reached take a dosage that matches the number where the two values meet Continue reading >>

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