# Intensive Diabetes Management ```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 &amp; 3.
If your child is on insulin to carbohydrate ratio with correction factor, complete pages
1, 2 &amp; 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
continue to
round as instructed
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
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 &frac12; 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
continue to
round as instructed
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
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