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Physiological Insulin Dosing

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.

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Physiological Insulin Dosing

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  1. 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

  2. Insulin-to-Carbohydrate Ratio 500 Rule: 500 divided by TDD Example: 500 / 50 = 10 Insulin to carb ratio = 1u for 10g 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 = 1u for 36mg/dl • 1500 rule Regular Insulin • 1500 divide by TDD=mg/dl drop in BG • Example: 1500/50 = 30 mg/dl • Insulin sensitivity ratio = 1u for 30mg/dl

  3. Establishing Starting Basal and Bolus Dosing Ms. Johnson has A1c 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 - 5units • 181-210 - 7units • 211-240 - 9units • 241-270 -11units

  4. 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 A1c 7.6 = average bg of 170mg/dl Target could be 120 mg/dl

  5. 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 1unit of Rapid Acting Insulin will be 5 carbs Using the 500 rule for rapid insulin as described: 500/90= 5 carbs

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

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