Calculation of insulin dose by bread units. Calculation of insulin dose (single and daily)

High concentrations of glucose in the blood have a detrimental effect on all systems of the body. It is characteristic of type 1-2 diabetes mellitus. Sugar increases due to insufficient production of the hormone by the pancreas or its poor absorption. If diabetes is not compensated for, then the person will face serious consequences (hyperglycemic coma, death). The basis of therapy is the introduction of short- and long-acting artificial insulin. Injections are required mainly for people with type 1 disease (insulin-dependent) and severe forms of the second type (non-insulin-dependent). The attending physician should tell you how to calculate the insulin dose after receiving the examination results.

Without studying special calculation algorithms, selecting the amount of insulin for injection is life-threatening, since a person can expect a lethal dose. An incorrectly calculated dosage of the hormone will reduce blood glucose so much that the patient may lose consciousness and fall into a hypoglycemic coma. To prevent consequences, the patient is recommended to purchase a glucometer to constantly monitor sugar levels.

Correctly calculate the amount of hormone by following the following tips:

• Buy special scales for measuring portions. They must capture mass down to fractions of a gram.
• Write down the amount of protein, fat, and carbohydrates you consume and try to take them in the same amount every day.
• Carry out a weekly series of tests using a glucometer. In total, you need to take 10-15 measurements per day before and after meals. The results obtained will allow you to more carefully calculate the dosage and ensure that the selected injection regimen is correct.

The amount of insulin for diabetes is selected depending on the carbohydrate ratio. It is a combination of two important nuances:

• How much does 1 IU (unit) of insulin cover consumed carbohydrates?
• What is the degree of sugar reduction after injection of 1 unit of insulin.

It is customary to calculate the stated criteria experimentally. This is due to the individual characteristics of the body. The experiment is carried out in stages:

• It is advisable to take insulin half an hour before meals;
• measure glucose concentration before eating;
• after the injection and finishing the meal, take measurements every hour;
• Based on the results obtained, add or reduce the dose by 1-2 units for full compensation;
• Correctly calculating the dose of insulin will stabilize sugar levels. It is advisable to write down the selected dosage and use it in a further course of insulin therapy.

High dosages of insulin are used for type 1 diabetes, as well as after stress or trauma. For people with the second type of disease, insulin therapy is not always prescribed and when compensation is achieved, it is canceled, and treatment continues only with the help of tablets.

The dosage is calculated, regardless of the type of diabetes, based on the following factors:

• Duration of the disease. If the patient has been suffering from diabetes for many years, then only a large dosage reduces sugar.
• Development of renal or liver failure. The presence of problems with internal organs requires a downward adjustment of the insulin dose.
• Excess weight. The calculation begins by multiplying the number of units of medication by body weight, so obese patients will need more medication than thin people.
• The use of third-party or hypoglycemic medications. Medicines can enhance or slow down the absorption of insulin, so when combining medication and insulin therapy, you will need to consult an endocrinologist.

It is better for a specialist to select formulas and dosages. He will assess the patient’s carbohydrate ratio and, depending on his age, weight, as well as the presence of other diseases and medications, will draw up a treatment regimen.

Dosage calculation

The dosage of insulin is different in each case. It is influenced by various factors throughout the day, so a glucometer should always be at hand to measure your sugar level and give an injection. To calculate the required amount of the hormone, you do not need to know the molar mass of the insulin protein, but simply multiply it by the patient’s weight (IU * kg).

According to statistics, 1 unit is the maximum limit for 1 kg of body weight. Exceeding the permissible threshold does not improve compensation, but only increases the chances of developing complications associated with the development of hypoglycemia (low sugar). You can understand how to choose the dose of insulin by looking at the approximate indicators:

• after diabetes is diagnosed, the basic dosage does not exceed 0.5 units;
• after a year of successful treatment, the dose is left at 0.6 units;
• if diabetes is severe, then the amount of insulin increases to 0.7 units;
• in the absence of compensation, the dose is set to 0.8 units;
• after identifying complications, the doctor increases the dosage to 0.9 units;
• if a pregnant girl suffers from type 1 diabetes, then the dosage is increased to 1 unit (mainly after the 6th month of pregnancy).

Indicators may vary depending on the course of the disease and secondary factors affecting the patient. The algorithm below will tell you how to correctly calculate the insulin dosage by choosing the number of units from the list above:

• No more than 40 units are allowed to be used at a time, and the daily limit varies from 70 to 80 units.
• How much to multiply the selected number of units depends on the patient’s weight. For example, a person weighing 85 kg and successfully compensating for diabetes for a year (0.6 units) should inject no more than 51 units per day (85*0.6=51).
• Long-acting (long-term) insulin is administered 2 times a day, so the final result is divided by 2 (51/2=25.5). In the morning the injection should contain 2 times more units (34) than in the evening (17).
• Short-acting insulin should be used before meals. It accounts for half of the maximum permissible dosage (25.5). It is distributed over 3 times (40% breakfast, 30% lunch and 30% dinner).

If glucose is already elevated before the introduction of the short-acting hormone, then the calculation changes slightly:

• 11-12 +2 units;
• 13-15 +4 units;
• 16-18 +6 units;
• 18> + 12 UNITS

The amount of carbohydrates consumed is displayed in bread units (25 g of bread or 12 g of sugar per 1 XE). Depending on the grain indicator, the amount of short-acting insulin is selected. The calculation is carried out as follows:

• in the morning, 1 XE covers 2 units of the hormone;
• at lunchtime, 1 XE covers 1.5 units of the hormone;
• in the evening the ratio of insulin and bread units is equal.

Calculation and technique of insulin administration

Insulin dosage and administration is important knowledge for any diabetic. Depending on the type of disease, slight changes in calculations are possible:

• In type 1 diabetes, the pancreas completely stops producing insulin. The patient has to take short-acting and long-acting hormone injections. To do this, take the total number of permissible units of insulin per day and divide by 2. The long-acting type of hormone is injected 2 times a day, and the short-term type at least 3 times before meals.
• In type 2 diabetes mellitus, insulin therapy is required if the disease is severe or if drug treatment does not produce results. Long-acting insulin is used for treatment 2 times a day. The dosage for type 2 diabetes usually does not exceed 12 units at a time. A short-acting hormone is used for complete depletion of the pancreas.

After completing all the calculations, you need to find out what technique for administering insulin exists:

• wash your hands thoroughly;
• disinfect the stopper of the medicine bottle;
• draw air into the syringe equivalent to the amount of insulin injected;
• Place the bottle on a flat surface and insert a needle through the stopper;
• release the air from the syringe, turn the bottle upside down and draw in the medicine;
• the syringe should contain 2-3 units more than the required amount of insulin;
• stick out the syringe and squeeze out the remaining air from it, while adjusting the dosage;
• disinfect the injection site;
• inject the medicine subcutaneously. If the dosage is large, then intramuscularly.
• Disinfect the syringe and injection site again.

Alcohol is used as an antiseptic. Wipe everything with a piece of cotton wool or a cotton swab. For better absorption, it is advisable to inject in the stomach. Periodically, the injection site can be changed on the shoulder and thigh.

How much does 1 unit of insulin reduce blood sugar?

On average, 1 unit of insulin lowers glucose concentration by 2 mmol/l. The value is checked experimentally. In some patients, sugar drops by 2 units once, and then by 3-4, so it is recommended to constantly monitor glycemic levels and inform your doctor about all changes.

How to use

The use of long-acting insulin creates the appearance of the pancreas working. Administration occurs half an hour before the first and last meals. Short-acting and ultra-short-acting hormones are used before meals. The number of units varies from 14 to 28. Various factors influence the dosage (age, other diseases and medications, weight, sugar level).

Just 20 years ago, diabetes was a very rare disease. There were no more than 30 million diabetics around the globe. But today this disease has been diagnosed in 415 million people on Earth. And, according to doctors’ forecasts, over the next 20 years this number will increase by another 1.5 times. This means that people need to be aware of this problem, and those who are already sick need to know how to calculate the dose of insulin.

When the body's metabolism of carbohydrates and water is disrupted, the pancreas begins to suffer. It is here that insulin, the human hormone, is produced. He does the job of processing sugar. If there is not enough sugar, then sugar remains in abundance in the blood, then is excreted along with the urine. And there is a lot of urine. Another characteristic feature of diabetes is poor water retention by body tissues. This moisture is called inferior.

Insulin helps deliver glucose molecules to the body's cells in the right quantities. If the pancreas does not produce it in the required quantity, then the sugar remains in the bloodstream, and the cells do not receive enough of it. Excess blood sugar is the main symptom of diabetes. This disease can be inherited or acquired independently. There are other symptoms that may indicate this disease:

• The mouth feels dry all the time.
• I am constantly thirsty, but water does not quench my thirst. People with a lack of insulin drink much more water than their daily dose.
• A lot more urine comes out of the person. Moreover, this applies to both one-time and daily portions.
• There is a weight jump in one direction or another. The scales can show either much more or much less.
• The skin constantly itches and becomes dry, as if dehydrated. In addition, pustular formations often appear on them, which are difficult to heal.
• There is a feeling of weakness in the muscles. Sweating increases significantly.
• Any wound remains open for a very long time as healing is delayed.

The presence of these symptoms should be an alarm bell and a reason to contact a specialist. First of all, a blood sugar test will be ordered. Over time, the disease progresses and leads to complications in all organs. These are serious pustular skin lesions and dental diseases, angina pectoris and atherosclerosis, diseases of the nervous system and kidneys, hypertension and a sharp deterioration in vision. If the disease is not diagnosed promptly and adequate treatment is not provided, complications from diabetes can threaten the patient's life.

Treatment of diabetes

Treatment of diabetes mellitus today has not progressed as far as it would be necessary for a complete cure. The best progress has been made in diet therapy. There are patients who manage to maintain normal blood tests simply by following the right diet and maintaining themselves with regular moderate physical activity. After some time, you can regain your health, but under no circumstances should you allow breakdowns. Along with the return of the wrong lifestyle, the disease will return.

Some patients benefit from therapeutic fasting. But this is a very dangerous path; you cannot follow it either alone or together with an inexperienced doctor. Good specialists in this field are quite rare, and amateurs can lead to intensive care and death.

Relatively recently, a kind of artificial pancreas has appeared. These are special devices that are located inside the human body and constantly monitor sugar levels. In case of deviations from the norm, the required dose is released into the bloodstream. The method shows good results, but it is very difficult to select the right insulin preparation.

The main problem of medicine in this area is the inability to synthesize insulin the same as that produced in the body of a particular patient. Synthetic analogs are not yet universal for everyone. Insulin-dependent people can only wait and hope that medical developments will finally solve this problem.

Classic treatment for diabetics is self-control and following the doctor’s precise instructions throughout your life. In this case, it is most often possible to avoid complications and severe disease. They try by all means to reduce the amount of glucose in the blood and normalize metabolic processes in the body.

Principles of classical treatment of diabetes mellitus

There is a standard treatment regimen designed for most patients. First of all, the patient must follow a diet. Each diabetic is taught in special classes how to correctly calculate the calorie content of dishes. In this process, carbohydrates, fats and proteins are taken into account. The selection of the insulin dose will be facilitated if food containing a carbohydrate load is taken at the same time. Following a meal, a dose of insulin is sent, which corrects the glucose level in the blood. In the event that treatment is done without an artificial hormone, the amount of calories consumed is limited and sugar in any form is prohibited.

Another prerequisite is to eat small meals 4-5 times a day. In this case, one of the most important conditions is that carbohydrates must be distributed evenly every time the patient sits down at the table. Thanks to this measure, the blood glucose level can be kept at a constant level. To make the task easier, you need to plan the menu in advance, and in stores pay attention to special shelves with products for diabetics. In mild cases of the disease, a proper diet is the only measure taken. And, of course, periodic monitoring of blood sugar.

And for those who are not so lucky and the disease has already progressed much further, doctors prescribe insulin therapy. Calculating the dose of insulin is a rather difficult task that cannot be done on your own, how to take it and what the doctor explains. Calculation of the dose and administration of insulin occurs gradually, while the level of glucose in both the blood and urine is constantly monitored. There are three types of hormone, they differ from each other by the time of action. There are drolong, intermediate and short-acting. The first one is prescribed to almost every patient, but it is supplemented with another one in order to compensate for the disease.

Insulin dose calculation

Diabetes mellitus of both the first and second types dictates the need to calculate how much insulin a patient needs per day, and what combinations of drugs should provide it. The first type means that the pancreas does not produce its own hormone, and the second means that tissue cells lose sensitivity to this hormone. The main question for any diabetic is how to choose the right dose of insulin to eliminate the imperfections of your body.

Scientific developments and modern production make it possible to produce artificial insulin in quantities that cover the needs of all patients. Production methods have been developed and improved, new ones are constantly being invented. If previously the medicine was produced on the basis of the insulin that was produced by the pancreas of some animals, now this is a great rarity and, in fact, a relic of the past. Such drugs have been replaced by products of modern technologies.

Calculating your insulin dose will be your shared responsibility with your doctor only at first. Such dependence on a doctor would sharply reduce the patient’s quality of life and tie him to a medical institution. There is even a special school for diabetics, which is available in many medical institutions. There they teach everything necessary for a full life, and first of all, correctly calculate the dose of insulin. It is important to stop the disease and in no case allow an overdose.

General calculation rules

The calculation algorithm is not particularly complicated, especially for those who use it regularly. The most important rule from which to initially proceed is that you cannot inject yourself with more than one unit of hormone per kilogram of body weight. If this principle is violated, a hypoglycemic coma will quickly occur. However, this is the maximum dose of insulin, not the recommended dose. To regulate injections, some other points need to be taken into account, but all calculations are based on the patient’s weight: the insulin dose is multiplied by the number of kilograms.

• The first stages of type 1 diabetes will require an insulin dose of 0.5 units per kilogram.
• If the disease belongs to the first type and it was successfully compensated for in a year, the selected doses are reduced to 0.6 units.
• Severe flows and significant fluctuations in sugar mean that the number of kilograms must be multiplied by 0.7.
• Decompensated diabetes means a dose of 0.8 units/kg.
• Gestational diabetes - 1 unit/kg.

Such a simple calculator shows the general patterns that insulin dictates; its doses can be adjusted, and sometimes quite significantly. After all, this is just the beginning of the calculations.

Insulin dose per bread unit

Bread units are a universal concept; for Russia it is 10 g of carbohydrates. It helps you understand what dose of the hormone you need to administer before meals based on what you are going to eat. Not the entire volume of food taken is taken into account, even if there are carbohydrates in it, but only individual foods. These are beets, carrots and potatoes; cereals; sweet-tasting fruits; actually sweets. Diabetics usually carry with them a special table that tells them the “cost” of food in XE. Although over time all sorts of aids are not needed, everything is remembered quite quickly.

Each piece of bread you are going to eat must be preceded by 1 unit of insulin. And, of course, both the meal and the injection should follow the determination of sugar by the glucometer. This device for a diabetic becomes a desktop device, one might say, a faithful companion. Only with its help will the calculation of the daily dose of insulin be correct. After all, with the help of another table you can understand how many units of medication need to be administered to reduce the excess amount of glucose that the glucometer showed.

General rules for administering insulin

How to choose an insulin dose is not all the difficulties that a patient will have to learn to overcome. The dosage of insulin must be injected into the body. Most often this is done subcutaneously. The dose is set using a special insulin syringe. There are also special pen syringes designed for subcutaneous injections. After setting the dose of the injection, a button is pressed or turned and the medicine enters the body.

Insulin, like any medicine, has its own instructions for use. Your doctor will definitely explain to you how to take it. Everything must take place under conditions of the strictest sterility and accuracy. The medicine is best absorbed if a subcutaneous injection is given in the stomach. The shoulder and gluteal muscles are in second place, and the worst thing is that the injection into the thigh is absorbed slowly and not completely. Doctors advise choosing different places for injections. It is best if you inject in the stomach in the morning, in the afternoon it will be in the shoulder, and in the evening - in the thigh.

All manipulations, medications and their doses will be worked out and determined by the doctor. Diabetes mellitus, no matter what type it is, is a disease that is subject to constant monitoring by both the patient and his attending physician. The possible complications are too severe and the list of them is long. The worst of them can lead to death.

Insulin therapy for type 1 diabetes mellitus

Types of insulin therapy

Intensified or basal-bolus insulin therapy

Long-acting insulin (LAI) is administered 2 times a day (in the morning and at night). Short-acting insulin (RAI) is administered before main meals and its dose depends on the number of bread units (XE) planned to be taken with food, the level of glycemia before meals, insulin requirements per 1 XE at a given time of day (morning, afternoon, evening) - a necessary condition is to measure glycemia before each meal.

Traditional insulin therapy

Long-acting insulin (LAI) is administered 2 times a day (morning and at night) Short-acting insulin (SAI) is administered 2 times a day (before breakfast and before dinner) or before main meals, but its dose and the amount of XE are strictly fixed ( the patient does not change the insulin dose and the amount of XE on his own) - there is no need to measure glycemia before each meal

Insulin dose calculation

Total daily insulin dose (TDID) = patient weight x 0.5 U/kg*

0.3 U/kg for patients with newly diagnosed type 1 diabetes during the period of remission (“honeymoon”)

0.5 U/kg for patients with an average history of the disease

0.7-0.9 U/kg for patients with a long history of the disease

For example, the patient’s weight is 60 kg, the patient has been sick for 10 years, then the SSDI is 60 kg x 0.8 U/kg = 48 U

If the SSDI is 48 units, then the dose of the IPD is 16 units, with 10 units administered before breakfast and 6 units before bedtime

The ICD dose is 2/3 of the SSDI.

However, with an intensified insulin therapy regimen, the specific dose of ICD before each meal is determined by the number of bread units (XE) planned to be taken with food, the level of glycemia before meals, the need for insulin for the first XE at a given time of day (morning, afternoon, evening)

The need for ICD in breakfast is 1.5-2.5 U/1 XE. at lunch - 0.5-1.5 U/1 XE, at dinner 1-2 U/1 XE.

In case of normoglycemia, ICD is administered only for food; in case of hyperglycemia, additional insulin is administered for correction.

For example, in the morning a patient’s sugar level is 5.3 mmol/l, he plans to eat 4 XE, his insulin requirement before breakfast is 2 U/XE. The patient must inject 8 units of insulin.

With traditional insulin therapy, the ICD dose is divided either into 2 parts - 2/3 is administered before breakfast and 1/3 is administered before dinner (If the SSDI is 48 U, then the ICD dose is 32 U, with 22 U administered before breakfast, and 10 U before hive) , or the ICD dose is divided approximately evenly into 3 parts, administered before main meals. The amount of XE in each meal is strictly fixed.

Calculation of the required amount of XE

The diet for type 1 diabetes is physiological isocaloric, its purpose is to ensure normal growth and development of all body systems.

Daily calorie intake - ideal body weight x X

X - amount of energy/kg depending on the patient’s level of physical activity

32 kcal/kg - moderate physical activity

40 kcal/kg - average physical activity

48 kcal/kg - heavy physical activity

Ideal body weight (M) = height (cm) - 100

Ideal body weight (F) = height (cm) - 100 – 10%

For example, a patient works as a cashier in a savings bank. The patient's height is 167 cm. Then her ideal body weight is 167-100-6.7, i.e. about 60 kg, and taking into account moderate physical activity, the daily calorie content of her diet is 60 x 32 = 1900 kcal.

Daily caloric intake is 55 - 60% carbohydrates

10 - 15% protein

Accordingly, the share of carbohydrates accounts for 1900 x 0.55= 1045 kcal, which is 261 g of carbohydrates.IXE = 12 g carbohydrates, i.e. Every day the patient can eat 261: 12 = 21 XE.

Breakfast 20 - 25%

Lunch 30 - 35%

Dinner 20 - 25%

Snacks 5-10%

Those. for breakfast and dinner, our patient can eat 4-5 XE, for lunch 6-7 XE, for snacks 1-2 XE (preferably no more than 1.5 XE). However, with an intensified insulin therapy regimen, such a strict distribution of carbohydrates among meals is not necessary.

Calculating the dose of insulin is a very important component of therapy. Several types of insulin are used in the treatment of diabetes mellitus; short insulin is injected frequently and requires special consideration in calculations.

A patient with insulin-dependent diabetes mellitus must know how to calculate the dose of insulin, since the person’s further well-being and performance throughout the day will depend on this calculation. If insulin is administered regularly according to the rules, then complications of diabetes mellitus can be delayed for a long time.

Calculation of short and ultra-short insulin

Does the patient even need to take short-acting insulin? This must be identified through careful self-monitoring, strictly following a certain algorithm of actions, which will subsequently allow the formation of an individual treatment regimen.

This approach to treatment for diabetes is called intensive insulin therapy, or basal-bolus therapy. It is this that helps achieve the maximum effect from insulin therapy.

Why do you need to take a few days to research and study your own blood sugar to calculate your insulin dosage? It’s all very simple: if you have severe diabetes mellitus, then it is simply necessary, in addition to extended insulin before the night’s rest and in the morning, to inject a bolus, or short-acting insulin, before each planned meal.

If your blood sugar concentration “jumps” only during a certain period of the day, for example, after dinner, then you will need to change the algorithm a little - perform an additional injection of the hormone only before dinner.

When exactly you need to administer insulin will have to be studied with strict self-control for 3 days. But it is better that you devote the whole week to this.

For the result of self-control to be informative, it is necessary to measure glucose before each meal and after 2-3 hours.

Features of intensive insulin therapy

When all the nuances of dosage are taken into account and an individual calculation of the insulin dose is made, the patient receives the following benefits from the basal-bolus regimen.

1. The maximum possible compensation for diabetes mellitus is achieved, while complications develop much later.
2. The length and quality of life with diabetes is increasing.
3. You do not need to adhere to the strictest eating regimen, as with the standard dose regimen. With the basal-bolus regimen, you can lead a completely active lifestyle with a flexible meal schedule.
4. The work of your own pancreas is imitated, which is more physiological.

But we cannot help but mention the disadvantages of this regime:

• constant and regularly frequent monitoring of sugar;
• you need to learn long and painstakingly to “manipulate” blood sugar;
• Hypoglycemic conditions are more common.

Standard dose regimen

If for some reason the patient cannot carry out self-monitoring, then he is prescribed a different insulin therapy regimen, namely traditional insulin therapy, or a standard dose regimen. Each insulin injection is pre-calculated, regardless of the individual’s individual characteristics. This introduction algorithm has more disadvantages than advantages, but still in some cases it has a right to exist. The advantages of this dosage:

• there is no need to study the theory of insulin administration a lot and for a long time;
• no need to identify sugar surges yourself;
• You don't need to control your sugar so often.

The disadvantages of the standard dose regimen include the following:

• the daily routine and diet are very strict;
• mandatory meals at least 5-7 times a day;
• Sufficient compensation for diabetes is not achieved, which leads to the development of complications;
• administration of insulin according to this scheme is not physiological;
• hypoglycemia often develops at night;
• Various circumstances under which it is necessary to reduce or increase the administered dose (stress, strain, fasting) are not taken into account.

We will not stop with this regimen, since all doses and administration algorithm will be suggested by the doctor. All that remains is to strictly follow the instructions.

Intensive insulin regimen

So, for a person to feel well with diabetes, his glucose level must be within the readings: 5.5 mmol/l and 3.5 mmol/l. To achieve this, you need to learn how to correctly calculate the dosage of the hormone to be administered before consuming food, depending on the amount of carbohydrates in this food. And for this, it is advisable to know what a bread unit (XE) is and have a table of products with XE in a visible place (for example, in your phone or on the refrigerator).

If a person has eaten food that does not have carbohydrates, then he does not need to be given insulin. And, conversely, if you plan to eat a piece of cake at a party, then the amount of insulin needs to be increased. And, as always, we must not forget about monitoring insulin before eating food and after 2-3 hours.

The following should be used as short-acting insulin administered before meals:

• Actrapid NM;
• Humulin Regular;
• Insuman Rapid GT or other as prescribed by a doctor.

To urgently lower blood sugar levels, you should always have Humalog, NovoRapid, Apidra - ultra-short insulins with you.

In each specific situation, you need to “start” with different doses of short-acting insulin, which depends on the severity of the condition, the type of diabetes, and the patient’s weight. Several cases should be considered separately to understand how the starting dosage of the hormone is calculated for type 1 or type 2 diabetes.

Severe type 1 diabetes or advanced type 2 diabetes

With this variant of the disease, patients need insulin injections up to 6 times a day. In diabetics with type 2 of the disease, pancreatic cells are subject to the same total destruction as in the first type of disease.

Basic injections are performed with extended-release or peak-free insulin (Lantus, Levemir, Protafan) at night and in the morning. For flexible insulin administration, it is necessary to calculate the dose in accordance with the planned carbohydrate intake.

In order not to make a mistake in calculating the starting dosage of “rapid” insulin, you need to remember the following points:

• short ones include Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R;
• the onset of action in their time range approximately coincides;
• ultra-short (for immediate effect) insulins (Humalog, NovoRapid, Apidra) are activated much faster than the previous ones; read about their dosage below.

In such a clinical situation, when a patient consumes 1 g of carbohydrates, plasma glucose will rise by 0.28 mmol/l, provided that the body weight is 63.5 kg. And one unit of insulin will reduce the rise in glucose by 2.2 mmol/l.

The administration of 1 unit of any short-acting insulin preparation will cover 8 grams of carbohydrates consumed. The same amount of hormone will cover 57 grams of protein.

So, let's start looking at a specific example of calculating the bolus dose in accordance with the amount of carbohydrates in grams and bread units. To do this, you need to have a kitchen scale, which determines the mass of the product down to tenths of a gram. You should also always have a table of bread units in the kitchen and at hand.

For example, for breakfast you plan to consume 7 grams of carbohydrates and 80 grams of protein. This means: 7g/8g and 80g/57g. These ratios are obtained if dietary carbohydrates and proteins are divided by the amount of carbohydrate and protein components of food covered by one unit of insulin. In total, we get 2.27 units of the hormone, which is necessary for breakfast. You should calculate in the same way for each subsequent meal.

We need to remind you that this is how we calculated the starting dose. Take a week to test this amount of insulin administered by measuring your blood sugar 2, 3, 4, and 5 hours after meals. But it is possible to draw a conclusion about the effectiveness of insulin therapy only after 4-5 hours after eating. It is at this time that insulin administered before meals stops working, and sugar from food has already been absorbed.

What is the criterion for correct dosage selection? We determined the insulin dose correctly if glycemia deviates by 0.6 mmol/l in one direction or another from that before meals.

How to change the insulin dose if, 4-5 hours after a meal, glucose deviates from this cherished figure? Then you need to calculate as follows. 1 unit of insulin can lower glycemia by 2.2 mmol/l (if the weight is equal to the previously mentioned 64 kg). If blood glucose, for example, after a morning snack rose by 4 mmol/l from the initial level, this, of course, means that it is necessary to slightly increase the insulin dosage, namely by 4/2.2 = 1.8 units. If the starting dose before breakfast was 2.27 units of insulin, then we will add another 1.8 units to them and get 4.07 units. If, on the contrary, glucose decreased, for example, by 2.5 units from the level before eating, then the dose is reduced by 2.5/2.2 = 1.13 units. Then the final dose will be 2.27-1.13 = 1.14 units. This method of adjustment needs to be tested for at least a week.

If plasma sugar “jumps,” then ultra-short insulin will come to the rescue. In the same case, when the pancreas does produce a certain amount of the hormone, the previously given dosages can cause. Therefore, you need to have glucose or candy with you.

Type 2 or mild type 1 diabetes

This variant of the disease assumes that the patient has already been prescribed long-acting insulin, which he administers in the morning and before bed. This therapy allows you to maintain baseline insulin levels within normal limits even in the event of a missed meal. But after a snack, sugar levels rise, despite increasing the dose of sugar-lowering medications.

In this case, it is necessary to administer short-acting insulin. It can be calculated using the strict self-control technique described above. This is the only way to achieve a positive result from treatment.

If you have been diagnosed with mild type 1 diabetes (LADA), then taking pills to lower your sugar makes no sense and can only cause harm by causing complications in the form of lactic acidosis.

Insulin calculation using XE

XE, or bread units, were introduced into diabetic use for the convenience of counting the amount of carbohydrates in food. You definitely need to have at hand (app on your phone, list in the kitchen) a table of products with bread units. Detailed tables can be found in.

1 XE is equal to 10-12 grams of carbohydrates. You might think that bread units were invented to completely confuse people with diabetes. But this is far from true! Few people always have a kitchen scale at hand. Bread units help to determine by eye the amount of carbohydrates in a serving of a particular food..

For example, a standard “canteen” piece of brown bread weighing 25 grams contains 1 XE. To cover 1XE of carbohydrates eaten, you will need from 1.4 to 2 units of insulin (for each individual). Visually, 1 XE of food with 12 grams of carbohydrates can fit in the palm of your hand. So, by looking at a carbohydrate food, you can determine how much XE it contains and how much short-acting insulin needs to be administered.

conclusions

At the end of the article, you should summarize and note the main aspects of calculating the dose of short-acting insulin.

1. Exclusive self-control and a week allocated to study your own body can help you choose an adequate dose of insulin, which will not allow complications to quickly develop.
2. Dose adjustment must occur if the course of the disease worsens, as well as in other situations when the need for this hormone may change (fasting, physical activity, stress, etc.).
3. Any changes in your condition should be reported to your doctor.
4. A standard dose regimen is acceptable if self-control is impossible for some reason. In this case, it is necessary to strictly adhere to the daily routine.

Remember that even the best professional endocrinologist will not be able to accurately select the optimal dose of insulin for you, he will only be able to monitor your hard work on self-control. Yes, this takes time and patience, but who else, if not you yourself, can keep this disease “in check.”

Insulin dose calculation: find out everything you need to know. Learn to manage with minimal doses and keep sugar 3.9-5.5 mmol/l stable 24 hours a day. It is possible to stop spikes in blood glucose levels even in severe type 1 diabetes in adults and children. And even more so, keep your sugar at normal levels, like healthy people, with type 2 diabetes. Understand how to select the optimal dose of insulin, taking into account the individual course of diabetes.

Read the answers to the questions:

You need to observe the behavior of blood sugar in a diabetic at different times for several days, and then select an insulin therapy regimen.

Please note that large doses of insulin are unstable and unpredictable. The strength of their action on different days may differ by ±56%. To have good diabetes control, you need to manage this problem. The main remedy is switching to, which reduces the dosage by 2-8 times.

Diabetics who limit their carbohydrate intake should not inject more than 8 units of insulin at a time. If you need a higher dose, divide it into 2-3 approximately equal injections. Do them one after another in different places with the same syringe.

Treatment of diabetes with insulin - where to start:

Many diabetics who are treated with insulin believe that episodes of low blood sugar cannot be avoided. They think that terrible hypoglycemia attacks are an inevitable side effect. In fact, You can keep your blood sugar at a stable level even with severe autoimmune disease. And even more so with relatively mild type 2 diabetes. There is no need to artificially increase your blood glucose levels to protect yourself from dangerous hypoglycemia. Watch a video that discusses this issue. Learn how to balance your diet and insulin doses.

Below are answers to questions that patients often have.

What foods contain insulin?

No foods contain insulin. Also, there are no tablets containing this hormone yet. Because when administered orally, it is destroyed in the gastrointestinal tract, does not enter the bloodstream and does not affect glucose metabolism. Today, insulin to lower blood sugar can only be introduced into the body through injections. Inhalation aerosols are available, but they should not be used because they do not provide an accurate and stable dosage. The good news is that the needles on insulin syringes and pens are so thin that you can learn how to use them.

At what blood sugar levels are insulin injections prescribed?

Except for the most severe cases, diabetics need to first switch to it and sit on it for 3-7 days, monitoring their blood sugar. It may turn out that you don't need insulin injections at all.

Read about tablets containing metformin:

After switching to a healthy diet and starting to take metformin, you need to collect information about the behavior of sugar during each day for 3-7 days. Having accumulated this information, it is used to select optimal doses of insulin.

Diet, metformin and physical activity should together bring glucose levels back to normal, as in healthy people - 3.9-5.5 mmol/l consistently 24 hours a day. If such indicators cannot be achieved, add more insulin injections.

Don’t agree to live with a sugar level of 6-7 mmol/l, much less higher! These numbers are officially considered normal, but in reality they are elevated. With them, complications of diabetes develop, albeit slowly. Hundreds of thousands of diabetics who suffer from problems with their legs, kidneys and vision bitterly regret that at one time they were too lazy or afraid to inject themselves with insulin. Don't repeat their mistake. Use low, carefully measured doses to achieve levels consistently below 6.0 mmol/L.

It is often necessary to inject extended-release insulin at night in order to have normal blood sugar the next morning on an empty stomach. Read. First of all, figure out whether you need injections of extended-release medications. If they are necessary, start doing them.

Read about long-acting insulin preparations:

Tresiba is such an outstanding drug that the site administration has prepared a video about it.

Once you start injecting insulin, don’t even think about giving up your diet. If you are overweight, continue taking the pills. Try to find time and energy to exercise.

Measure your sugar before each meal and 3 hours after it. It is necessary to determine within a few days after which meals the glucose level regularly increases by 0.6 mmol/l or more. Before these meals you need to inject short or ultra-short insulin. This supports the pancreas in situations where it does not cope well on its own. Read more about choosing the optimal dosage before meals.

Important! All insulin preparations are very fragile and easily spoil. Study them and follow them diligently.

Sugar levels of 9.0 mmol/l and higher may be detected, even despite strict adherence to the diet. In this case, you need to immediately start giving injections, and only then add other medications. Also, people with type 1 diabetes and thin people who have been diagnosed with type 2 diabetes start using insulin immediately after a low-carb meal, bypassing the pill.

If blood glucose levels are high, insulin therapy should be started immediately; it is harmful to procrastinate.

What is the maximum dose of insulin per day?

There are no restrictions on the maximum daily dose of insulin. It can be increased until the glucose level of a diabetic patient returns to normal. Professional journals describe cases where patients with type 2 diabetes received 100-150 units per day. Another issue is that high doses of the hormone stimulate fat deposits in the body and worsen the course of diabetes.

The site teaches you how to keep your blood sugar consistently normal 24 hours a day and still manage with minimal doses. Read more and. First of all, you should go to . Diabetics who are already being treated with insulin, after switching to a new diet, should immediately reduce the dosage by 2-8 times.

How much insulin is needed for 1 bread unit (XE) of carbohydrates?

It is believed that for one unit of bread (XE) eaten for lunch or dinner, you need to inject 1.0-1.3 units of insulin. For breakfast - more, up to 2.0-2.5 units. In fact, this information is not accurate. It is better not to use it for actual calculation of insulin doses. Because different diabetics have different sensitivity to this hormone. It depends on the patient's age and weight, as well as other factors listed in the table below.

A pre-meal dose of insulin that would be appropriate for an adult or teenager may kill a small diabetic child. On the other hand, a tiny dose that would be sufficient for a child would have virtually no effect on an overweight adult with type 2 diabetes.

You need to carefully figure out through trial and error how many grams of carbohydrates eaten are covered by 1 unit of insulin. Approximate data is given in. They need to be clarified individually for each diabetic, accumulating statistics on the effect of injections on his body. - this is a real and serious danger. To avoid it, treatment begins with obviously low, insufficient doses. They are slowly and carefully increased at intervals of 1-3 days.

Diet options depending on diagnosis:

The website explains how to use it to treat diabetes. By switching to this diet, you can stop spikes in glucose levels and keep your blood sugar at a stable 3.9-5.5 mmol/l, like in healthy people.

Diabetics who follow a healthy diet count their carbohydrate intake in grams rather than grain units. Because grain units only cause confusion without bringing any benefit. On a low-carbohydrate diet, the maximum carbohydrate intake does not exceed 2.5 XE per day. Therefore, it makes no sense to calculate insulin doses by bread units.

How much does 1 unit of insulin reduce blood sugar?

Materials from the Federal State Budgetary Institution “Endocrinological Research Center” of the Ministry of Health of the Russian Federation say that 1 unit of insulin reduces blood sugar by an average of 2.0 mmol/l. This figure is clearly underestimated. Using this information is useless and even dangerous. Because insulin works differently for all diabetics. It has a much stronger effect on thin adults, people with type 1 diabetes, and children. Except in cases where storage rules were violated and the insulin deteriorated.

Different preparations of this hormone differ significantly in strength. For example, ultra-short types of insulin Humalog, NovoRapid and Apidra are approximately 1.5 times stronger than short-acting Actrapid. The types of extra-long-acting, extended-acting, intermediate-acting, short-acting and ultra-short-acting insulin each work differently. They affect blood sugar differently. The purposes of their administration and the methods for calculating dosages are not at all similar. It is impossible to use any average performance indicator for all of them.

Read about short-acting and ultra-short-acting insulin preparations:

Example. Let's say you have determined through trial and error that 1 unit of NovoRapid reduces your glucose level by 4.5 mmol/l. After that, you learned about the miraculous and switched to it. says that short-acting insulin is better suited for a low-carbohydrate diet than ultra-fast insulin. Therefore, you are going to change NovoRapid to Actrapid, which is approximately 1.5 times weaker. To calculate your starting dose, you assume that 1 unit will lower your blood sugar by 4.5 mmol/L / 1.5 = 3.0 mmol/L. Then, within a few days, you will clarify this figure based on the results of the first injections.

Each diabetic needs to use trial and error to find out exactly how much 1 unit of insulin he injects reduces his glucose level. It is not advisable to use an average figure taken from the Internet to calculate your individual doses. However, you have to start somewhere. You can use the following information provided by Dr. Bernstein to calculate your starting dose.

approximately by 3 mmol/l. The more the patient weighs and the higher the fat content in his body, the weaker the insulin works. The relationship between body weight and the strength of insulin is inversely proportional and linear. For example, in an obese patient with type 2 diabetes weighing 126 kg, 1 unit of Humalog, Apidra or NovoRapid will reduce sugar approximately by 1.5 mmol/l.

To calculate the appropriate dose, you need to make a proportion taking into account the body weight of the diabetic. If you don't know how to make a proportion and can't count without making mistakes, it's better not to even try. Seek help from someone advanced in arithmetic. Because an error in the dosage of potent rapid insulin can have serious consequences, even kill the patient.

Training example. Let's say a diabetic weighs 71 kg. His rapid insulin is, for example, NovoRapid. By calculating the proportion, you can find out that 1 unit of this drug will reduce sugar by 2.66 mmol/l. Did your answer match this figure? If yes, then it's ok. Let us repeat that this method is only suitable for calculating the first, starting dose. The figure you get by calculating the portion needs to be clarified based on the results of the injections.

How much sugar reduces 1 unit depends on body weight, age, level of physical activity of the person, the drug used and many other factors.

Factors affecting insulin sensitivity

The higher the sensitivity, the more each administered unit (IU) of insulin lowers sugar. Approximate figures are given in, as well as in. This data can only be used to calculate the starting dosage. Then they need to be clarified individually for each diabetic based on the results of previous injections. Don’t be lazy, carefully select the optimal dosage to keep your glucose level 4.0-5.5 mmol/l stable 24 hours a day.

How many units of insulin are needed to reduce sugar by 1 mmol/l?

The answer to this question depends on the following factors:

• age of the diabetic;
• body mass;
• level of physical activity.

Several other important factors are listed in the table above. Having accumulated information over 1-2 weeks of injections, you can calculate how much 1 unit of insulin lowers sugar. The results will be different for long-acting, short-acting and ultra-short-acting drugs. Knowing these numbers, it is easy to calculate the dose of insulin that will reduce blood sugar by 1 mmol/l.

Keeping a diary and doing calculations is a hassle and takes up some time. However, this is the only way to select optimal dosages, maintain stable normal glucose levels and protect against diabetes complications.

When will the results of the injection appear?

This question requires a detailed answer because different types of insulin take effect at different rates.

Insulin preparations are divided into:

• extended - Lantus, Tujeo, Levemir, Tresiba;
• medium - Protafan, Biosulin N, Insuman Bazal GT, Rinsulin NPH, Humulin NPH;
• fast acting - Actrapid, Apidra, Humalog, NovoRapid, domestic.

There are also two-phase mixtures - for example, Humalog Mix, NovoMix, Rosinsulin M. However, it is not recommended to use them. They are not discussed on this site. To achieve good control of diabetes, you need to switch from these drugs to the simultaneous use of two types of insulin - long-acting and fast (short or ultra-short).

It is further assumed that the diabetic follows and receives low doses of insulin that correspond to it. These doses are 2-7 times lower than those to which doctors are accustomed. Treatment of diabetes with insulin according to Dr. Bernstein's methods allows you to achieve stable blood sugar levels of 3.9-5.5 mmol/l. This is real even with severe disorders of glucose metabolism. However, low-dose insulin starts working later and stops working sooner than standard high-dose insulin.

Fast (short and ultra-short) insulin begins to act 10-40 minutes after the injection, depending on the drug administered and dose. However, this does not mean that after 10-40 minutes the glucometer will show a decrease in sugar. For the effect to appear, you need to measure your glucose level no earlier than after 1 hour. It is better to do this later - after 2-3 hours.

Study the details. You should not inject large doses of these drugs to get a quick effect. You will almost certainly inject yourself with more of the hormone than you should, and this will lead to hypoglycemia. There will be hand trembling, nervousness and other unpleasant symptoms. Even loss of consciousness and death are possible. Handle rapid-acting insulin with care! Before using, thoroughly understand how it works and how to determine the appropriate dosage.

Medium- and long-acting insulin preparations begin to work 1-3 hours after the injection. They give a smooth effect that is difficult to track with a glucometer. A single sugar measurement may not reveal anything. You need to self-monitor your blood glucose levels several times every day.

Diabetics who give themselves long-acting insulin injections in the morning see their results in the evening, based on the results of the whole day. It is useful to build visual graphs of sugar levels. On the days when extended-release insulin was given, they will differ significantly for the better. Of course, if the dose of the drug is correctly selected.

An injection of extended-release insulin given at night gives results the next morning. Fasting sugar levels improve. In addition to measuring in the morning, you can also monitor your glucose levels in the middle of the night. It is advisable to check your sugar at night in the first days of treatment, when there is a risk of overdoing the starting dose. Set an alarm to wake up at the right time. Measure your sugar, record the result and continue sleeping.

Research before starting diabetes treatment with this remedy.

How much insulin should be injected if a diabetic’s blood sugar is very high?

The required dose depends not only on blood sugar, but also on body weight, as well as on the individual sensitivity of the patient. There are many factors that affect insulin sensitivity. They are listed above on this page.

It will be useful to you. Short-acting and ultra-short-acting drugs are administered to diabetics when they need to quickly reduce high sugar levels. Long-acting and intermediate-acting insulin should not be used in such situations.

In addition to insulin injections, diabetics will benefit from drinking plenty of water or herbal tea. Of course, without honey, sugar and other sweets. Drinking liquid dilutes the blood, reduces the concentration of glucose in it, and also helps the kidneys remove some of the excess glucose from the body.

A diabetic needs to determine exactly how much 1 unit of insulin reduces his glucose level. This can be learned over a period of days or weeks through trial and error. Each time the dose is calculated, the resulting figure must be adjusted for weather, infectious diseases and other factors.

There are situations when sugar has already jumped, you need to bring it down urgently, but you have not yet had time to accumulate accurate data by trial and error. How to calculate the insulin dose in this case? You will have to use indicative information.

You can use the dose calculation method below at your own peril and risk. An overdose of insulin can cause unpleasant symptoms, impaired consciousness and even death.

In an adult with a body weight of 63 kg, 1 unit of ultra-short insulin Humalog, Apidra or NovoRapid lowers blood sugar approximately by 3 mmol/l. The greater your body weight and the higher your body fat content, the weaker your insulin works. For example, in an obese patient with type 2 diabetes weighing 126 kg, 1 unit of Humalog, Apidra or NovoRapid will reduce sugar approximately by 1.5 mmol/l. It is necessary to make a proportion taking into account the body weight of the diabetic.

If you don’t know how to make a proportion, and you’re not sure that you can calculate it accurately, then it’s better not to even try. Seek help from someone competent. An error in the dosage of short-term or ultra-fast insulin can have serious consequences, even kill the patient.

Let's say a diabetic weighs 71 kg. His rapid insulin is for example Apidra. Having drawn up the proportion, you calculated that 1 unit will reduce sugar by 2.66 mmol/l. Let's say the patient's blood glucose level is 14 mmol/l. It needs to be reduced to 6 mmol/l. Difference with target: 14 mmol/l - 6 mmol/l = 8 mmol/l. Required insulin dose: 8 mmol/l / 2.66 mmol/l = 3.0 units.

Let us repeat once again that this is an approximate dose. It is guaranteed not to be a perfect fit. You can inject 25-30% less to reduce the risk of hypoglycemia. This calculation method should only be used if the patient has not yet accumulated accurate information through trial and error.

The drug Actrapid is approximately 1.5 times weaker than Humalog, Apidra or NovoRapid. It also takes effect later. However, Dr. Bernstein recommends using it. Because short-term insulin is better compatible with a low-carbohydrate diet than ultra-short insulin.

The insulin dose calculation method given above is not suitable for diabetic children. Because their sensitivity to insulin is several times higher than that of adults. An injection of rapid insulin in a dose calculated according to the indicated method will most likely cause severe hypoglycemia in the child.

What are the features of calculating the dose of insulin for diabetic children?

In diabetic children before adolescence, insulin sensitivity is several times higher than in adults. Therefore, children require negligible doses compared to adult patients. As a rule, parents who control diabetes in their children have to dilute insulin with saline solution purchased at the pharmacy. This helps to accurately inject doses of 0.25 units.

Above, we discussed how to calculate the insulin dose for an adult with a body weight of 63 kg. Let's say a diabetic child weighs 21 kg. It can be assumed that he will need a dose of insulin 3 times less than an adult, with the same blood glucose levels. But this assumption will be incorrect. A suitable dose will most likely be not 3, but 7-9 times less.

Diabetic children are at significant risk of episodes of low blood sugar caused by insulin overdose. To avoid an overdose, start insulin injections with deliberately low doses. Then they are slowly increased until the blood glucose level becomes stably normal. It is undesirable to use potent drugs Humalog, Apidra and NovoRapid. Try Actrapid instead.

Children under 8-10 years old can start injecting insulin with a dose of 0.25 units. Many parents doubt that such a “homeopathic” dose will have any effect. However, most likely, you will notice the effect from the first injection based on the glucometer readings. If necessary, increase the dose by 0.25-0.5 units every 2-3 days.

The information on calculating insulin doses given above is suitable for diabetic children who strictly adhere to the dose. Fruits and others should be excluded completely. The child needs to be explained the consequences of eating junk food. There is no need to use an insulin pump. However, it is advisable to wear a continuous glucose monitoring system if you can afford it.