Physiological Insulin Dosing Establishing Starting Basal and Bolus

Physiological Insulin Dosing Establishing Starting Basal and Bolus Dosing Based on Pre-Meal Readings and Carb Counting Determining the starting Carb Ratio and Correction Factor Total Daily Dose Split to mimic Euglycemic control 50% Basal 50% Bolus

Insulin-to-Carbohydrate Ratio 500 Rule: 500 divided by TDD Example: 500 / 50 = 10 Insulin to carb ratio = 1 u for 10 g Insulin Sensitivity or Correction Factor 1800 rule Humalog/Novolog/Apidra 1800 divide by TDD= mg/dl drop in BG Example: 1800/50 = 36 mg/dl Insulin sensitivity ratio = 1 u for 36 mg/dl 1500 rule Regular Insulin 1500 divide by TDD=mg/dl drop in BG Example: 1500/50 = 30 mg/dl Insulin sensitivity ratio = 1 u for 30 mg/dl

Establishing Starting Basal and Bolus Dosing Ms. Johnson has A 1 c of 7. 6 and is on Glargine (Lantus) 60 units at bedtime Lispro(Humulog) sliding scale with average daily dose of 30 units Usually takes 3 correction shots based on pre-meal readings: If BG is 120 -150 - 3 units 151 -180 - 5 units 181 -210 - 7 units 211 -240 - 9 units 241 -270 -11 units

Establishing Starting Basal and Bolus Dosing Ms. Johnson’s starting Glargine dose is 45 units Her total daily dose is 90 units and using the 50/50 ratio her basal dose would be 45 units. Her target should be established at no more than 50 mg/dl below average BG A 1 c 7. 6 = average bg of 170 mg/dl Target could be 120 mg/dl

Establishing Starting Basal and Bolus Dosing Ms. Johnson’s sensitivity to 1 unit of Rapid Acting insulin will be: 20 mg/dl Using the 1800 rule for rapid insulin as described: 1800/90= 20 mg/dl Ms. Johnson’s carb ratio to 1 unit of Rapid Acting Insulin will be 5 carbs Using the 500 rule for rapid insulin as described: 500/90= 5 carbs

Putting Basal/Bolus dosing to use Ms. Johnson’s pre-lunch reading is 220 mg/dl and she is going to eat 70 carbs her dose of Apidra would be: Carb ratio is 5 carbs/unit so 70/5 =14 1. 5 units for food 2. 14 units Sensitivity is 20 mg/dl/unit to a target of 120 so 220 mg/dl -120 mg/dl =100 mg/ dl 3. 16 units so 100/20= 5 units for correction 4. 19 units 14 units for food 5. 23 units +5 units for correction 19 units total needed