Concerns About Insulin Therapy
Pain, weight gain, and hypoglycemia may occur with insulin therapy. Pain is associated with injection therapy and glucose monitoring, although thinner and shorter needles are now available to help decrease pain. Weight gain associated with insulin therapy is due to the anabolic effects of insulin, increased appetite, defensive eating from hypoglycemia, and increased caloric retention related to decreased glycosuria. In the U.K. Prospective Diabetes Study, patients with type 2 diabetes who were taking insulin gained an average of 8 lb, 13 oz , which was associated with a 0.9 percent decrease in A1C level compared with patients on conventional therapy.5
Hypoglycemia may occur from a mismatch between insulin and carbohydrate intake, exercise, or alcohol consumption. Hypoglycemia has been associated with an increased risk of dementia and may have implications in cardiac arrhythmia. 6,7 All patients should be instructed on the symptoms and treatment of hypoglycemia. American Diabetes Association guidelines recommend that the blood glucose level be checked if hypoglycemia is suspected , then treated with a fast-acting carbohydrate, such as juice or glucose tablets. The blood glucose level should be rechecked after 15 minutes to make sure it has normalized.8
How Much Insulin Is Too Much To Take For High Blood Sugar
Ideally, you should be able to correct your blood sugar with an appropriate insulin dose. How much insulin is too much varies based on how sensitive your body is to insulin.
If you have higher-than-expected blood sugar , you should check your urine for ketones. The presence of ketones suggests your bodys cells are having trouble getting enough glucose. You could be at risk for a serious condition called diabetic ketoacidosis if you have ketones in your urine.
In this instance, you need extra help correcting your blood sugar. You should seek emergency medical attention instead of trying to keep injecting insulin to lower your blood sugar.
The General Principles Of Sliding Scale Therapy Are:
- The amount of carbohydrate to be eaten at each meal is pre-set.
- The basal insulin dose doesnt change. You take the same long-acting insulin dose no matter what the blood glucose level.
- The bolus insulin is based on the blood sugar level before the meal or at bedtime
- Pre-mixed insulin doses are based on the blood sugar level before the meal
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How Much Insulin To Take For Bodybuilding
Injecting insulin is not a safe approach to weight training. However, some bodybuilders will inject it as a performance-enhancing drug. They believe injecting insulin will allow energy in the form of glucose to enter their cells so they can build more muscle.
This practice is unsafe and can lead to severe and potentially life threatening hypoglycemia, according to 2019 research.
You should not take insulin unless you have diabetes. If you do have diabetes, talk with your doctor about how your training regimen may affect your blood sugar levels.
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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Youll Need To Calculate Some Of Your Insulin Doses
Youll 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.
Lets Look At An Example
Lets say that you check your blood sugar before a meal and its 170. Youll need 1 unit to adjust to your target of 120.
If you plan to eat a meal that has 60 grams of carbohydrates, youll need to give yourself 6 units of insulin to adjust for your meal.
This means youll need 7 units total.
If your child needs help learning to calculate their insulin needs, Childrens Healthcare of Atlanta has created a helpful worksheet just for this.
Remember, there are two components to insulin correction:
- your blood sugar levels before your meal
- corrections for the carbohydrates you eat
Combine both of these when considering how much insulin to inject.
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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.
Important Safety Information For Lantus
Contraindications
Lantus is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients.
Warnings and PrecautionsInsulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles.
Monitor blood glucose in all patients treated with insulin. Modify insulin regimen only under medical supervision. Changes in insulin regimen including, strength, manufacturer, type, injection site or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment.
Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis may result in hyperglycemia sudden change in the injection site has been reported to result in hypoglycemia. Advise patients to rotate injection site to unaffected areas and closely monitor for hypoglycemia.
Do not dilute or mix Lantus with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus via an insulin pump or intravenously because severe hypoglycemia can occur.
Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus, and may be life-threatening.
Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus, treat and monitor until symptoms resolve.
Drug Interactions
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Calculating A Bolus Dose For Carbohydrate
- Use the Insulin to Carbohydrate Ratio to calculate your insulin dose.
- ICR is the amount of rapid-acting insulin you need for a specific amount of carbohydrate in food. This is the number of grams of carbohydrates that 1 unit of rapid-acting insulin will cover.
- Example: 1 unit of rapid-acting insulin will cover 10 grams carbohydrates. This may also be written 1:10.
NOTE: You may give insulin right after a meal if do not know the amount of carbohydrates that will be eaten, like with a very young child or sickness.
-
Do not give rapid-acting insulin when you eat carbohydrate to treat a low blood glucose or to prevent a low blood glucose.
Questions To Ask Your Doctor
- How can I determine my insulin-to-carb ratio and insulin sensitivity factor ?
- Under what circumstances should I adjust my ratio and ISF?
- When does it make sense to use a set amount of units of insulin?
- Is the Plate Method more suitable for me?
- What if I miss a dose of mealtime insulin?
- What do I do if my blood sugar is high prior to eating?
- How do I calculate my insulin dosages while dining out?
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Intensive Insulin Therapy Is The Standard Method Of Insulin Replacement
This page includes a list of what your medical provider should prescribe when designing an insulin regimen for you.
The main goal in designing an insulin regimen is to mimic how the body normally releases insulin. If you have type 2 diabetes, there are two main ways to replace insulin. Intensive Insulin Therapy closely mimics the natural insulin production. The second, referred to as Conventional or Sliding Scale Insulin Therapy, more loosely approximates insulin needs.
How Do You Determine Insulin Dosage
Once you know how sensitive you are to insulin, you can figure out how much insulin you need to give yourself to lower your blood sugar by a certain amount.
For example, if your blood sugar is 200 mg/dL and youd like to use your short-acting insulin to lower it to 125 mg/dL, youd need your blood sugar to drop by 75 mg/dL.
From the insulin sensitivity factor calculation, you know that your short-acting insulin sensitivity factor is 1:60. In other words, one unit of short-acting insulin lowers your blood sugar by about 60 mg/dL.
How much insulin do you then need to lower your blood sugar by 75 mg/dL?
Youll need to divide the number of mg/dL you want to lower, which is 75, by the number from your insulin sensitivity factor calculation, which is 60. The answer of 1.25 tells you that you need to take 1.25 units of short-acting insulin to lower your blood sugar by 75 mg/dL.
These are rough calculations that are used by people with type 1 diabetes. If you have type 2 diabetes, youll need to check with your doctor for guidance.
Many oral medications are safe and effective when combined with insulin therapy. To maximize benefit without causing significant adverse effects, it is important to consider the mechanism of action for different therapies.
Alpha-glucosidase inhibitors delay absorption of carbohydrates in the gastrointestinal tract to decrease postprandial hyperglycemia. These medications are safe and effective when combined with insulin.39
Read the full article.
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Usual Adult Dose For Diabetes Type 1
Note: Regular human insulin is available in 2 concentrations: 100 units of insulin per mL and 500 units of insulin per mL Doses should be individualized based on patient’s metabolic needs, blood glucose monitoring results, and glycemic goals
- Total daily insulin requirements are generally between 0.5 to 1 unit/kg/day
Insulin U-100 :
- Insulin U-100 should generally be used in a regimen with an intermediate or long-acting insulin
- Humulin R: Dilute to a concentration of 0.1 to 1 unit/mL in an infusion system using polyvinyl chloride infusion bags this insulin is stable in normal saline
How Do You Determine Your Insulin
To figure out a rough estimate of your I:C ratio, divide the number 500 by your total daily dose of insulin, which includes both long-acting and rapid-acting insulin. This is known as the 500 rule.
To roughly calculate your correction factor, take the number 1,800 and divide that by your TDD. This is known as the 1,800 rule.
Remember, always work with your care team to finely tune both your I:C ratio and correction factor.
Most insulin pumps now do this math automatically when recommending a bolus of insulin. However, for people taking multiple daily injections, calculating these figures manually is required for all meals, snacks, and drinks.
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Initiating Appropriate Insulin Therapy
The American College of Endocrinology and the American Association of Clinical Endocrinologists recommend initiation of insulin therapy in patients with type 2 diabetes and an initial A1C level greater than 9 percent, or if the diabetes is uncontrolled despite optimal oral glycemic therapy. 11 Insulin may be used alone or in combination with oral medications, such as metformin . This recommendation is based on expert opinion, and not on the results of randomized controlled trials comparing different approaches in patients with an initial A1C level greater than 9 percent.
In the U.K. Prospective Diabetes Study, early intensive glucose control starting with a sulfonylurea, then metformin, then insulin was associated with a 25 percent reduction in microvascular complications and a 12 percent risk reduction in any diabetes-related end point, but was not associated with a reduction in all-cause mortality. 5 A subgroup of patients randomized to intensive therapy with metformin alone had a 36 percent reduction in all-cause mortality. 12 This supports current ADA guidelines that recommend using metformin as first-line pharmacologic therapy however, additional therapies need to be added if diabetes is not controlled with metformin alone.
Choosing The Correct Type Of Insulin
Insulin regimens should be tailored to the patient’s needs and lifestyle. One of the most important considerations is the pharmacokinetics of different insulin preparations 26 . Table 2 defines commonly used terms in insulin therapy.
| Insulin type |
|---|
| Calculation | ||
|---|---|---|
| Use of either basal or bolus insulin to help improve glucose control in patients with partial beta-cell failure | 0.3 unit per kg | |
| Replacement | Use of basal and bolus insulin to control blood glucose when endogenous insulin production is minimal or absent | 0.6 to 1.0 unit per kg |
| Carbohydrate ratio | The number of units of insulin needed to cover for a certain number of grams of carbohydrates ingested | 500 divided by total daily insulin |
| Correction | How much 1 unit of insulin is expected to decrease the patient’s blood glucose level when the blood glucose level is above predefined targets, short-acting insulin may be added to the bolus dose or given separately between meals | 1,500 divided by total daily insulin |
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Putting It All Together
Now that you know the how and why behind insulin dosing, lets consider how you may calculate your insulin needs.
Youll usually give yourself an insulin dose around your meals since thats when you take in carbohydrates. You also will typically check your blood sugar to see if youre meeting your premeal target dose.
To calculate your insulin needs:
You may find that if you generally eat about the same amount of carbohydrates each day, you may be able to consistently inject the same amounts of insulin outside of special occasions. It takes time to find out how your body best responds to insulin.
Internationalizing These Findingsshould Dietary Patterns Matter
The dosing guidelines in CSII in India and China recommend the same dosing formulas as AACE/ACE, i.e., TBD=50 % of TDD and CIR=450/TDD. This seems questionable because the diet composition in these nations is markedly different from the US diet that was probably consumed in the Davidson and Walsh studies. The American diet is approximately 49 % carbohydrate and 38 % fat, compared to 61% and 27 %, respectively, in China, and 71% and 19 %, respectively, in India .
How might dietary carbohydrate differences affect dosing formulas across different cultures? The denominator for the TBD formula, TDD, is the summation of the TBD and total bolus dose. Increasing the dietary carbohydrates would increase the total bolus dose, increasing the TDD but not the TBD, resulting in lower recommendations for the TBD/TDD ratio. For example, every 10 % increase in dietary carbohydrates and assuming 1800-calorie diet, CIR=10 g/U, no corrective boluses, and a TBD=10 U, there would be a 10 % decrease in the TBD/TDD ratio.
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How Many Units Of Insulin Do You Need For High Blood Sugar
You will need 6 units of rapid acting insulin to cover the carbohydrate. Next, you have to calculate the high blood sugar correction dose. ÷ correction factor. 1 unit will drop your blood sugar 50 points and the high blood sugar correction factor is 50. Pre-meal blood sugar target is 120 mg/dl.
How many grams of insulin for breakfast and lunch?
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.
Example : High Fat Meal
60gm carbohydrates, 30gm fat and moderate protein, ICR=15
60gm carbs divided by 15 = 4 units of insulin
Add 30% more to 4 units of insulin calculated: 0.3×4 = 1.2 units insulin
Add 1.2 units to 4 units mealtime insulin dose: 4+1.2 = 5.2 units insulin
Divide total insulin need for meal by 50% or half of the insulin calculated: 5.2 divided by 2 = 2.6 units insulin
Bolus or inject 2.6 units insulin 15 minutes before the meal and then another bolus or inject another 2.6 units insulin 2-3 hours after the meal.
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