Adjusting insulin algorythm

[jimmys devoted]

Adjusting insulin for either type 1s or type 2s is basic math.
You ned to know your weight converted to Kilograms
and you need to know your BMI.
The reason for BMI is to dtermine of you are obese, overweight that will need .05 units per kilo or if you are within a normal range of .02U per kilo.

In either case this is considered your basal rate or LOng acting rate.
divide your weight by 2.2 and you ahve your Kilo weight.
Multiply your kilo bu\y either .02 or .05. Thats your insulin basal dose.

If you eat carbs you have to consider how much of a bolus you will need.
That will be dtermined by your CDE.

However a sliding scale of insulin for R is mandatory.
Usually starting at 160-18- for 2 units and then graduating up.


j

[parise]

oh my goodness isnt your doctor suppose to measure all that out for you so you know how much insulin you need?

[jimmys devoted]

Many doctors simply use a sliding scale and give you an approximate amout to use. for example.. a flat rate of 10 units 15 minutes prior to a meal.

when you get into insulin useage, you are taught this formula to make sure that you are adjusting and using it correctly.

I ahd to figure out my insuloin useage simply because my doctor said take 25 units throughout the day.
which was less than half my basal rate according to standards.

[bra]

Nice calculations. So, do you adjust it up
when you are intaking more carbs?

I see that you give a way to figure in
carbohydrates in your example,
but it hasnt made it in to my brain yet.

My partner takes the same amount each day
as prescribed. He gets dizzy sometimes
and has been advised time and again to
make sure to get some food in him right
around the same time of the injections.

But he's supposed to eat regularly and small
meals all day. NOT just at shot time!:o

[jimmys devoted]

here is what is the current clinical and prescribing views are:

Eat 15 minutes after taking your basal shot if you are in target range only. If you are below normal range for you then you must eat something!

eat anormal meal at breakfast....

at lunch pre test eat normally and then do a 2 hour post prandial.
EAt a 3pm 309 gram snack

then eat a normal dinner.

at 9 pm eat a 30 gram carb snack.
this does afew things: this keeps glucose monitoring in check, the idea is to maintina a check before each meal or snack and if needed take a shot and adjust carb intake.
For me I do this: and my numbers are different so bear in mind adjust for as needed.
I do a fasting in teh am.. if i fall below 75 I eat 15 grams of somethinng anything I take no shot. I am way too low to take a shot. I have to be above 85 ot take a shot or il will drop too low.
After I eat i wait abnotu 30 minutes I test again to see if I am up high enough to take a shot and then eat.

If i am I eat alice high fiber decadent breakfast or a favorite shake.

then at lucnh I test again.
Morning lows are a combination of a few great important factors:
1 he is in ultimate control.........2: his diet and regimine is highly effective
3 meds are correctly balanced.

in am dropdowns though he may also be experienced 3 am problems. Its a good idea ot see how high he is at 3Am. Noone really can pinpoint why at 3am your body goes haywire but its been studied and it neverfails at abotu 3am your body does some crazy things.
So testing at 3am might be a good idea.

IN summation do a test: if you are belwo at least 85 do not take ashot until after you eat and bring your BG level up. Then test again,, if its tsill not high enough eat again and then after all is done take your shot. Its better in some cases to err on the side of caution then risk hypoglycemia.

[bra]

Okay you lost me right off the bat, what is taking a basal shot?

[jimmys devoted]

A basal does stems from the word base. Its the dose of insulin that your doctor suggests as your starting out amount.
For me that 52 units of Lantus. Thats my base dose.
anything I add after that is called a bolus or added on amount insulin to help copmpensate for over indulgence of carb, illness or other reasons your glucose spikes an elevation.

[Team Diabetes]

This is a great idea for a thread. I just wanted to say that I believe the correct factor is usually .5-1.0 units per Kg of body weight. If someone is very insulin sensitive, .2 would not be unheard of. Many Type 1 diabetics (the severe non-preventable insulin requiring kind usually first diagnosed in children) would need small amounts like this. Average would be about .5

In some Type 2 diabetics, their insulin resistance is very severe, and they are overweight. In this case they may need 1.0 units/Kg.

I just did some quick calculations, and .02-.05 is definitely too small of a number, so I'm guessing Jimmy's Devoted meant to say, .2-.5, am I right?

Anyway, yes, your doctor should be doing these calculations for you, unless you are a nurse or doctor yourself (or you are a real keener!). Most people here should be able to have their doctor figure this out for them, so don't worry! If your doctor sends you away without information like this, it's time for a new doctor!

There are many factors that can affect your insulin dose aside from weight (this is just a starting point), so these need to be considered. For example, your degree of insulin resistance (in Type 2 diabetes), or if you also have insulin antibodies (in Type 1 diabetes). Hormone levels and other medical problems also play a role.

Usually your bolus (fast acting insulin given at meal times) is started at 1 unit per 15 grams of carbs of carbohydrate you eat. It is mostly trial and error will the help of your diabetes care team.

Some people will need a higher ratio (1 unit for 20 grams of carbs), some will need a lower one (1 unit for 5 grams of carbs). Usually Type 2 diabetics need the ratio like the last one, since they are very insulin resistant.

The fast acting insulin that most people use now is called "Humalog" or "Novolog". It works very fast and is out of your system sooner, more like "normal" insulin. Some Type 2 diabetics use the older "R" insulin. It is not as fast and lasts longer.

Your "correction" factor is the amount of insulin needed to bring down a high blood sugar. Usually the average starting point is 1 unit will bring you down 3 mmol/l (54 mg/dl in the US). You will need to adjust this ratio up or down.

Some people need different ratios for different times of the day, depending on hormones, activity, etc.

Your diabetes care team and doctor will know how to figure this out for you. If you use an insulin pump, you can often lower you total daily insulin dose and have even better control.

[Sebo.PL]

I'm taking 1 unit per 7.69g of carbohydrates for breakfast and dinner and 1 unit per 14.29g for lunch. When my glucose is out of target I also take 1 unit per each 35mg/dl above 100mg/dl

I don't need to wait after injection. I just count my meal carbs, test blood, take the insulin and immediately start eating. I also do not need to care about time. With my insulin i can eat when I'm hungry. The only thing I should care is to inject 18u long insulin at 22:00 every evening and 16u just after I woke up. And that's my main problem :/ I use to forgot about evening injections.

[Chris]

I used to have the very same problem that you are speaking of. I had to take a shot of Lantus every night at around 9:30 and if I was out, it was hard to remember sometimes to take the shot. I then went onto the pump and it all changed, I no longer had to worry about taking any shots at all, and the basal insulin was automatically injected into me through the pump. If the pump is an option, I highly recommend researching it.

[halfnelson]

My math must be rusty 'cause I get 3.75 and that can't be my basal dose.....:confused:

[faithib]

My dr started my basal dose at a certain point but it has changed over time.
I am on the pump and have 2 different basal rates to cover different parts of the month.
I also wanted to say that I bolus not because I over-indulged in carbs but to cover the carbs I eat.
There is a difference.
When I eat I have to cover those carbs. If I put it in my mouth I cover it. The basals won't do that.
I also bolus to cover if my blood sugars are higher than usual for any unexplained reason and believe me that can happen a lot as a diabetic.
I used to have a 1 to 10 ratio to cover carbs, that is I took 1 unit of insulin for every 10 carbs I ate but now that I am taking Symlin I am on a 1 to 12 ratio and that may change.

[Sebo.PL]

Hi!!
I've also got type 1 diabetes and now when I'm finishing my masters degree from Information Technology at Wroclaw University of Technology I thought that "Adjusting insulin algorythm" would be a nice idea to make some research.
I'm going to make a system that will help people with diabetes to keep their blood glucose level in range. It will suggest how much insulin do you need based on information about your past and current blood glucose level, amount of eaten carbohydrates, weight and height, past amounts of given insulin.
But to make my research I need lots of real data which I could test the algorithm on. So if anyone of you could share with me your readings please contact me by mail at cukrzyca [at] pwr.wroc.pl
The project has also its website https://www.cukrzyca.pwr.wroc.pl but it is made in Polish ;]

[faithib]

This is a great idea for a thread. I just wanted to say that I believe the correct factor is usually .5-1.0 units per Kg of body weight. If someone is very insulin sensitive, .2 would not be unheard of. Many Type 1 diabetics (the severe non-preventable insulin requiring kind usually first diagnosed in children) would need small amounts like this. Average would be about .5

In some Type 2 diabetics, their insulin resistance is very severe, and they are overweight. In this case they may need 1.0 units/Kg.

I just did some quick calculations, and .02-.05 is definitely too small of a number, so I'm guessing Jimmy's Devoted meant to say, .2-.5, am I right?

Anyway, yes, your doctor should be doing these calculations for you, unless you are a nurse or doctor yourself (or you are a real keener!). Most people here should be able to have their doctor figure this out for them, so don't worry! If your doctor sends you away without information like this, it's time for a new doctor!

There are many factors that can affect your insulin dose aside from weight (this is just a starting point), so these need to be considered. For example, your degree of insulin resistance (in Type 2 diabetes), or if you also have insulin antibodies (in Type 1 diabetes). Hormone levels and other medical problems also play a role.

Usually your bolus (fast acting insulin given at meal times) is started at 1 unit per 15 grams of carbs of carbohydrate you eat. It is mostly trial and error will the help of your diabetes care team.

Some people will need a higher ratio (1 unit for 20 grams of carbs), some will need a lower one (1 unit for 5 grams of carbs). Usually Type 2 diabetics need the ratio like the last one, since they are very insulin resistant.

The fast acting insulin that most people use now is called "Humalog" or "Novolog". It works very fast and is out of your system sooner, more like "normal" insulin. Some Type 2 diabetics use the older "R" insulin. It is not as fast and lasts longer.

Your "correction" factor is the amount of insulin needed to bring down a high blood sugar. Usually the average starting point is 1 unit will bring you down 3 mmol/l (54 mg/dl in the US). You will need to adjust this ratio up or down.

Some people need different ratios for different times of the day, depending on hormones, activity, etc.

Your diabetes care team and doctor will know how to figure this out for you. If you use an insulin pump, you can often lower you total daily insulin dose and have even better control.

I bolus 1 for 10 for carbs.
Since I've been taking Symlin it has changed to 1 for 12.
That could go up.
I take 1 for 50 for a correction bolus.
My basals have been hard to figure out.
We think it is fixed and then it changes.
Diabetes is all about balance, or it seems to be for me.

[jimmys devoted]

My daily dose is base don Merck Manual of diagnostics.
they have insulin for weight as basal.
If you are obese you use
.5 units per kilogram of body weight.
So for me
.5 units X 102 kilos = 52 units basal or N insulin.

Then i use the sliding scale for elevtaed glucose. So starting with 180-190mg.dl 2-4 units R
and so on. For teh last four years its been working very well.

julie