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Intensive Diabetes Management (Multiple Daily Injections) Practice Sheet Intensive insulin therapy is taking three or more insulin injections a day. You may have a fixed insulin dose (for example: 5 units Novolog, Humalog or Apidra before each meal or snack) or use an insulin to carbohydrate ratio (for example: 1 unit of Novolog, Humalog or Apidra for every 15 grams of carbohydrate). Your doctor will decide which option is best for you and your child. If your child is on a fixed dose with a correction factor go to page 2 & 3. If your child is on insulin to carbohydrate ratio with correction factor, complete pages 1, 2 & 4. , The diabetes educator and dietitian will work with you to explain insulin to carbohydrate ratio and offer practice problems. Below we have included extra problems to make you more comfortable with using insulin to carbohydrate ratio. Insulin to Carbohydrate Ratio For example your child’s insulin dose will be written as: 1 unit insulin for every 15 grams of carbohydrates eaten or 1 unit / 15 grams Example: (1) 45 grams eaten (2) 68 grams eaten (45 grams / 15 grams) x 1 unit = 3 units (68 grams / 15 grams) x 1 unit = 4.5 units ↓ How do you round? Let’s use 4.3 units as an example to round: If you round to the closest half unit then 4.3 units = 4.5 units If you round down to the closest half unit then 4.3 units = 4 units If you round to the closest whole unit then 4.3 units = 4 units Practice problems: Grams of carbs eaten These are only examples; please continue to round as instructed by your child’s diabetes educator Total insulin to give 45 ____________ 38 ____________ 75 ____________ 52 ____________ 66 _____________ did not eat ______________ Remember, the insulin to carbohydrate ratio is to cover meals (and snacks if instructed by your child’s healthcare provider). 1 Correction Factor Correction factor bolus allows a high blood sugar level to return to target within 3 – 5 hours. Your diabetes doctor will write the formula for you. This is not something you or your child has to memorize or guess at. Use with rapid acting insulins only i.e.: Novolog, Humalog or Apidra. Correction factor is given in addition to meal dose. Can be used at other times as long as it has been 2 ½ to 3 hours since the last dose of rapid acting insulin or as instructed by your child’s healthcare provider. Definition: Correction Dose = (Actual blood sugar – Target range) / Insulin sensitivity (how much 1 unit of insulin will change your blood sugar) We will use [blood sugar – 150/50] as the correction factor for this practice. Examples: (1) Blood sugar = 300 at lunch 300 (blood sugar) – 150 (target range) / 50 (how much 1 unit insulin will change your child’s blood sugar) = 3 units (2) Blood sugar = 345 at lunch 345 (blood sugar) – 150 (target range) / 50 (how much insulin will change your child’s blood sugar) = 3.9 units ↓ How do you round? Let’s use 3.9 units as an example to round: If you round to the closest half unit then 3.9 units = 4 units If you round down to the closest half unit then 3.9 units = 3.5 units If you round to the closest whole unit then 3.9 units = 4 units. These are only examples; please continue to round as instructed by your child’s diabetes educator Practice problems: Blood sugar: 200 340 229 450 132 279 Remember, the correction dose is for the high blood sugar. 2 Fixed Insulin Dose + Correction Factor For this practice session the correction factor will be: Correction Factor = blood sugar – 150 / 50 Example Blood sugar 335 Insulin dose 1.5 units Correction factor (335 – 150) = 150 / 50 = 3.7 units Total amount to give 1.5 + 3.7 = 5.2 units I round to the closest half unit so I would give 5 units. Blood Sugar 175 Fixed Insulin Dose Blood sugar – 150 / 50 Total amount to be given 7 units 225 3.5 units 275 10 units 450 5 units 300 1.5 units 372 3 units 3 Insulin Carbohydrate Ratio + Correction Factor For this practice session the insulin to carbohydrate ratio = 1 unit per 15 grams of carbohydrate Example Blood sugar 335 Correction factor Carbohydrates (335 – 150) = 150 / 50 = 3.7 units (covers the high blood sugar) 60 grams (60 grams / 15 grams) x 1 unit= 4 units (covers the meal) Total amount to be given = 3.7 units + 4 units = 7.7 units I round to the closest whole unit so I would give 8 units. Blood Sugar Grams of Carb Eaten 175 45 grams 225 38 grams 275 75 grams 450 43 grams 300 66 grams 372 45 grams Blood sugar – 150 / 50 Total amount to be given 4