What Is An Intensive Insulin Regimen
Intensive insulin regimens attempt to mimic the bodys normal pattern of insulin secretion, and deliver replacement insulin using the concepts of basal and bolus insulin coverage.
When you are intensively managed with insulin your medical provider will prescribe an insulin regimen for you, but these are the general principles:
Effect Of The Amount Of Fat On Postprandial Glucose In Type 1
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- Fat reduces the postprandial glucose response 2â3 hours after eating and delays the peak glucose response due to delayed gastric emptying.
- Fat causes delayed hyperglycaemia 3â5 hours after eating.
- Additional insulin may be required for high fat meals which can increase blood glucose.
- There are marked interindividual differences in the effect of fat on postprandial blood glucose.
- Further research is needed to identify the amount of fat which affects glycaemia and whether the type of fat makes a difference.
Insulin Therapy In People With Type 2 Diabetes
For the treatment with insulin mixtures, the following principles established by ADA should be followed in the majority of people with type 2 diabetes :
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Initially, the usual dose of the basal insulin should be divided, and 2/3 of the dose should be administered before the morning and 1/3 of the dose before the evening meal.
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The insulin dose should be adjusted by adding 1 to 2 U or 10% to 15% once or twice a week until the target values in the glucose self-monitoring are obtained. In case of 4 blood glucose measurements per day, the insulin dose before the breakfast should be adjusted to control the blood glucose concentration after lunch and before supper, and the dose administered before the dinner should be changed to control the blood glucose measured before bedtime and before breakfast.
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If hypoglycemia occurs, the appropriate insulin dose should be reduced by 2 to 4 U or 10% to 20%.
Practically, the system based on the results of both glycemic and glycemic-after-prone tests is a combined treatment with GLP-1 agonist and the basal insulin. However, this treatment is effective only in those people with type 2 diabetes who have preserved endogenous insulin secretion.
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High Blood Sugar Correction
In step two, you will account for your current blood glucose concentration. It needs to be measured directly before the meal with your glucose meter. Your doctor should tell you what your target level of your premeal blood glucose is. Depending on the guidelines, your premeal glucose target may range from 80 to 130 mg/dL. If you measure your blood glucose in mmol/l, you can use our blood sugar converter. The third value you need to know is the insulin sensitivity factor. Again, it can be determined by your doctor, or you can calculate it when the total daily dose of insulin is known . Insulin sensitivity factor tells you by how many points one unit of insulin will decrease your blood glucose by.
The High Blood Sugar Correction Factor:
Correction Factor = 1800 ÷Total Daily Insulin Dose = 1 unit of insulin will reduce the blood sugar so many mg/dl
This can be calculated using the Rule of 1800.
Example:
= 1800 ÷ TDI = 1 unit insulin will drop reduce the blood sugar level by 45 mg/dl
While the calculation is 1 unit will drop the blood sugar 45 mg/dl, to make it easier most people will round up or round down the number so the suggested correction factor may be 1 unit of rapid acting insulin will drop the blood sugar 40-50 mg/dl.
Please keep in mind, the estimated insulin regimen is an initial best guess and the dose may need to be modified to keep your blood sugar on target.
Also, there are many variations of insulin therapy. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team.
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Insulin Calculator For Type 1 Diabetes
- This article reviews a range of approaches to calculating insulin requirements for people with type 1 diabetes.
- The simplest approach is standard carbohydrate counting, which may be ideal for someone whose diet is dominated by carbohydrates.
- Bernstein recommends standardised meals for which the insulin dose is refined based on ongoing testing and refinement.
- Stephen Ponders sugar surfing builds on carbohydrate counting, with correcting insulin given when blood glucose levels rise above a threshold due to gluconeogenesis.
- The food insulin index approach predicts insulin requirements based testing in healthy people of the insulin response to popular foods.
- The total available glucose advocates a dual wave bolus where insulin for the carbohydrates is given with the meal, with a second square wave bolus given for the protein which is typically slower to digest and metabolise.
Dietary Fat Acutely Increases Glucose Concentrations And Insulin Requirements In Patients With Type 1 Diabetes
OBJECTIVE Current guidelines for intensive treatment of type 1 diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting. There is strong evidence that free fatty acids impair insulin sensitivity. We hypothesized that patients with type 1 diabetes would require more insulin coverage for higher-fat meals than lower-fat meals with identical carbohydrate content. RESEARCH DESIGN AND METHODS We used a crossover design comparing two 18-h periods of closed-loop glucose control after high-fat dinner compared with low-fat dinner. Each dinner had identical carbohydrate and protein content, but different fat content . RESULTS Seven patients with type 1 diabetes successfully completed the protocol. HF dinner required more insulin than LF dinner and, despite the additional insulin, caused more hyperglycemia . Carbohydrate-to-insulin ratio for HF dinner was significantly lower . There were marked interindividual differences in the effect of dietary fat on insulin requirements . CONCLUSIONS This evidence that dietary fat increases glucose levels and insulin requirements highlights the limitations of the current carbohydrate-based approach to bolus dose calculation. These findings point to the need for alternative insulin dosing algorithms for higher-fat meals and suggest that dietary fat intake is an important nutritional consideration for glycemic control in individuals with type 1 diabetes. Current guidelines for the inContinue reading > >
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New Online Calculator For The Diabetes Math Impaired
Those of us living with diabetes, especially type 1, feel like were never-ending math story problems.
How many units do you take if you want to eat X amount of carbs, at a current blood sugar of Y, with a sensitivity factor of Z that varies due to time of day, amount of sleep, any stress you may be experiencing, or which way the wind is blowing?
We are walking D-Math calculators.
Technology makes it easier, without a doubt. Insulin pumps automatically calculate boluses for meals and corrections, and many keep track of how much active insulin we have working at any given time. Apps can do some D-Math too, but the need to pull out your phone for every bolus is not for everyone.
Thats why it was exciting to hear about the new Diabetes Calculator for Kids, a new, online program that can do D-calculations for you.
Its developed by Nationwide Childrens Hospital in Columbus, OH. But dont be deceived by the names: this free resource can actually help any PWD, of any age.
After my moms recent ER and hospital experience that temporarily affected her D-Math ability in a big way, we turned to this online calculator tool to do the calculations for us. And it worked perfectly!
The Diabetes Calculator is apparently the first of its kind which is somewhat amazing, because its really nothing fancy beyond a web-based version of a programmable spreadsheet.
Your Insulin Regimen Will Include:
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Effect Of Protein On Postprandial Glucose In Type 1 Diabetes
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- Protein does have an effect on postprandial glycaemia.
- This effect is delayed by approximately 1.5 hours.
- A smaller amount of protein will affect blood glucose when consumed with at least 30 g of carbohydrate but, without carbohydrate, at least 75 g is needed to produce an effect.
Further support for the delaying effect of protein on glycaemia comes from a study in type 2 diabetes where the postprandial response was significantly reduced when the protein component of a meal was consumed 15 minutes before the carbohydrate component compared to when protein was consumed after the carbohydrate.
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 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 6-30 grams or more of carbohydrate depending on an individuals 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
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 sugar, one unit of insulin is needed to drop the blood glucose by 50 mg/dl. This drop in blood sugar can range from 30-100 mg/dl or more, depending on individual insulin sensitivities, and other circumstances.
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Example #: Carbohydrate Coverage At A Meal
First, you have to calculate the carbohydrate coverage insulin dose using this formula:
CHO insulin dose = Total grams of CHO in the meal ÷ grams of CHO disposed by 1 unit of insulin .
For Example #1, assume:
- You are going to eat 60 grams of carbohydrate for lunch
- Your Insulin: CHO ratio is 1:10
To get the CHO insulin dose, plug the numbers into the formula:
CHO insulin dose =
- The carbohydrate coverage dose is 6 units of rapid acting insulin.
- The high blood sugar correction dose is 2 units of rapid acting insulin.
Now, add the two doses together to calculate your total meal dose.
Carbohydrate coverage dose + high sugar correction dose = 8 units total meal dose!
The total lunch insulin dose is 8 units of rapid acting insulin.
Type Of Meal: The Impact Of Protein & Fat
Carbs might be whats converted into glucose in the bloodstream the fastest, but its not the only macronutrient that can impact your blood sugar.
If you eat large amounts of protein, youll most likely need to inject insulin to not see an increase in your blood sugar.
If you add large amounts of fat to your meal, youll most likely see a delayed release of the glucose into your bloodstream, which for many people means that they need to take two insulin doses rather than just one .
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Effect Of Insulin Bolus Calculations For Fat And Protein
Insulin doses are usually calculated by dividing the amount of carbohydrate in the meal or snack by the patient’s insulin to carbohydrate ratio . This is added to any correction dose needed to bring the pre-meal glucose into the target range. This is calculated using the insulin sensitivity factor. An example is given in Box .
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How To Calculate Your Carb Ratio
If you suspect that your carb ratio is off , its time to collect data in the form of blood sugar readings and do some analysis.
If you want good results you need good data, and youre the only one who can collect it. As with most other things related to diabetes, it requires work but its worth it.
I suggest following the 4 steps below for 3-5 days minimum to collect data for you or your doctor to assess whether your carb ratio is correct. If you and/or your doctor dont see any trends after 3-5 days, youll have to collect more blood sugar data.
After 3-5 days, you should have enough data to start assessing whether your carb ratio for this time of day is accurate.
When you or your doctor does the analysis, youll focus on whether your blood sugar was in your desired range before the meal and whether your blood sugar came back into your desired range within 90-120 minutes of your insulin injection.
Blood sugar in-range before the meal, but high 90-120 minutes after
Advantages Of Intensive Insulin Regimens
- While intensive regimens require more calculation at each meal, they allow for more flexibility in timing and in the amount of carbohydrate content in meals and snacks.
- An accurate insulin dose will also result in better blood glucose control with fewer high and low blood sugars.
- Changes in activity and stress can be accommodated without sacrificing glucose control.
- Over time, high blood glucose correction can be separated from the food coverage. For example, if your blood sugar is very high , you can delay your meal and give yourself a correcting dose. Once your blood sugar falls below 200 mg/dl, you can inject your meal insulin and then eat.
- Learning these important skills will make managing your diabetes easier.
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Total Daily Insulin Requirement:
= 500 ÷ TDI = 1unit insulin/ 12 g CHO
This example above assumes that you have a constant response to insulin throughout the day. In reality, individual insulin sensitivity varies. Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times. In such a case, the background insulin dose would still be approximately 20 units however, the breakfast insulin-to-carbohydrate ratio might be breakfast 1:8 grams, lunch 1:15 grams and dinner 1:12 grams.
The insulin to carbohydrate ratio may vary during the day.
Automatic Bolus Calculators In People With Type 1 Diabetes
In people with type 1 diabetes, prandial insulin doses are individualized using parameters such as the insulin-to-carbohydrates ratio, and much less frequently, the circadian fluctuations of this parameter. However, in most algorithms the meal is characterized just by carbohydrate content despite the fact that new insights concerning the effect of dietary macronutrients on postprandial glycemia confirm that fat and protein content should be taken into consideration while calculating prandial insulin doses . Pankowska and Blazik showed that the insulin bolus calculator with an algorithm accounting for carbohydrates and protein and/or fat in the meal could effectively suggest a normal or a square-wave bolus and indicate the timing of the square-wave bolus in the insulin pump users . The same authors demonstrated in a 3-month open label randomized control study that the use of this system by educated children and adolescents with type 1 diabetes was safe and reduced 2-h postprandial blood glucose level and glucose variability .
Summing up, the improvement in the postprandial plasma glucose control in people with type 1 diabetes depends primarily on properly adjusting the insulin dose to the meal being consumed.
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