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Can you answer my question about insulin

Question:

says… TAMMARA) writes: I am a pharmacist and one of my diabetic clients asked me how many units of insulin does it take to make blood glucose go up or down x number of mg/dl. Dose," by Eric A Orzeck, M.D., F.A.C.P., _Diabetes Self Management_, March/April 1995, [good explanation of calculation method deleted]

Also remember that for many of us, the redudction of bg by a given amount of insulin is not a constant.  It takes more insulin to reduce bg by a given amount if the bg’s are high than if they are low. —

Response:

| Assuming the diabetic is normally in good control, divide his/her normal | 24-hour insulin dosage (all types) into 1500 to approximate the amount | of glucose reduction (mg/dl) that one *additional* unit of insulin will | produce.  For example, my normal dosage is 8R/12NPH in the morning, and | For what it’s worth, I have learned through trial and error that | one unit of reg lowers my bg by 60 units.         It should also be noted that the more overweight         a person is, the more insensitive that person is         likely to be to insulin and therefore requires more.         Also, the consumption of foods high in fat content         lowers insulin sensitivity.  On the other hand, exercise         heightens insulin sensitivity.         Foods which are readily absorbed into the bloodstream         such as highly processed foods like white bread, sugar,         candy, etc. also require larger amounts of insulin.         Only trial and error will determine what is best for         your client.         But as a rule of thumb, your client should take as         much regular insulin 30 minutes before a meal so         that he obtains "good control" over his blood         sugars.  Good control is generally defined as         having a blood sugar of 180 one hour after beginning         a meal, and 140 two hours after.

Response:

Assuming the diabetic is normally in good control, divide his/her normal 24-hour insulin dosage (all types) into 1500 to approximate the amount of glucose reduction (mg/dl) that one *additional* unit of insulin will produce.  For example, my normal dosage is 8R/12NPH in the morning, and

For what it’s worth, I have learned through trial and error that one unit of reg lowers my bg by 60 units. Using this equation I get the same answer! total dose = 14.2 units basal, 4.5 R for lunch, 6.0 R for dinner. Total per day = 24.7 units 1500/24.7 = 60.7 Pumping Insulin also has a chart of what 1 units of regular will do based on body weight.  - betsy

Response:

TAMMARA) writes: I am a pharmacist and one of my diabetic clients asked me how many units of insulin does it take to make blood glucose go up or down x number of mg/dl. I am in the process of learning as much as possible about diabetes, but I cannot answer his question yet. Can someone help me. thanks Randy Tammara

Dose," by Eric A Orzeck, M.D., F.A.C.P., _Diabetes Self Management_, March/April 1995, and assumes that the individual is closely monitoring his/her BGs with a meter to minimize the risk of a hypoglycemic episode.   Assuming the diabetic is normally in good control, divide his/her normal 24-hour insulin dosage (all types) into 1500 to approximate the amount of glucose reduction (mg/dl) that one *additional* unit of insulin will produce.  For example, my normal dosage is 8R/12NPH in the morning, and 8R/10NPH in the evening for a total of 38 units; dividing 38 into 1500 yields approx. 39 mg/dl.  So … if I overindulged at a restaraunt one night, and had a fasting BG the next morning of 220 mg/dl, the rule-of-thumb suggests an additional 3 units of Regular, so my adjusted dosage would be:  Regular:  8 (normal) + 3 (additional) = 11  NPH:     12 (unchanged) yielding a custom mix of 11R/12NPH … a total of 23 units, vs. the normal morning dosage of 20 units.   where the additional 3 units of regular would compensate for (3 x 39 equals) 117 mg/dl leaving an adjusted base of 103 mg/dl (220-117).   Note that the adjustments (if any) are made with Regular (short acting) insulin.  This method works pretty well for me when I keep my weight under reasonable control, and get adequate (at least four times a week) amounts of aerobic exercise.  When I’ve gained a few pounds, and/or gotten careless about my exercise program, I’ve noticed that the method doesn’t work as consistently … presumably because of increased insulin resistance.   It’s important to note that the above method is a starting point that will give someone a direction towards a treatment goal; IMMV, so fine-tuning may be required to match an individual’s specific situation.  Also … this is very important … tweaking the Regular component of injected insulin to compensate for BG highs and lows is *NOT* suitable for all diabetics; it’s strongly recommended that the insulin-using diabetic discuss the technique with their physician as a *possible* adjunct to their treatment regimen … and be guided by what their doctor recommends.  I hope this helps … Ted Rodrick  (Insulin-requiring Type II)

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