# Insulin Formulas

The insulin start formulae below may be based on basal bolus insulin therapy (BBIT at http://bbit.ca/ ), Diabetes Canada Guidelines or accepted practice.

## Basal Insulin Start

When basal insulin is added to non-insulin antihyperglycemic agents consider:

Diabetes Canada Guidelines: 10 units to start (individualized)

BBIT Guidelines: 0.1 to 0.2 units/kg = units basal insulin

• E.g. 100 kg X 0.1 or 0.2 = 10-20 units starting basal dose 100 kg client
• Tip: Take weight in kg and move decimal to the left for the LOWEST starting dose.
Double that number for the highest starting dose.
• Actual needs can be significantly higher, particularly in those who are resistant, however start conservatively.

## Bolus Insulin Start

Diabetes Canada Guidelines: 2 - 4 units per meal

BBIT Guidelines: 0.05 - 0.1 units / kg = units per meal

• E.g. 100 kg X 0.05 or 0.1 = 5 -10 units
• Tip: Take weight in kg and move decimal to the left for the HIGHEST starting bolus dose per meal. Cut this in half for the lowest starting bolus dose per meal.
• When to start bolus: If on > 0.5 units basal insulin per kg and not at target, consider adding bolus soon (consider A1c, age, complexity, etc).
• Actual bolus needs can be significantly higher, particularly in those who are resistant, however start conservatively.

## Basal & Bolus Start

• Starting TDD = 0.5 - 1.0 units/kg/day
(0.3 - 0.5 u/kg/day if more sensitive to insulin; 0.5 - 1.0 u/kg/day if more insulin resistant)
• Daily basal insulin =  50% of TDD
• Daily bolus insulin =  50% of TDD  (distributed amongst 3 meals)
• Or, if mixed insulin (e.g. 30/70) loosely 2/3 of TDD premix at breakfast and 1/3 at supper.
• Tip: If resistant consider this shortcut:
• half the weight in kg = total daily basal units
• half the weight in kg = total daily bolus units (distribute over 3 meals)
• Example for 100 kg resistant patient
• 50 units basal
• 50 units bolus
(50 / 3 meals = 16 units per meal but preferable to individualize.
e.g. if breakfast is small and supper large, then distribute it proportionately)

## Assessing % Basal in BBIT

• Total daily units basal / total daily units all insulin x 100 = % of insulin as basal
e.g. 45 units basal for the day / 90 units TDD x 100 = 50% of insulin as basal
• For most people, approximately 40-60% of their total daily dose of insulin (TDD) is basal insulin. This split varies for those on partial-closed-loop insulin pumps due to algorithms. For those with low carbohydrate diets, expect a higher % basal.

## Insulin Sensitivity Factor (ISF) or Correction Dose

To create an Insulin Sensitivity Factor (ISF) for RAPID insulin:

• 100/TDD = number of mmol/L 1 unit rapid will lower glucose level.
E.g. 100/50 units TDD = 2
1 unit will drop glucose by about 2 mmol/L

To create an Insulin Sensitivity Factor (ISF) for REGULAR insulin:

• 83/TDD = number of mmol/L 1 unit regular insulin will lower glucose level.
E.g. 83/30 units TDD = about 3.
1 unit will lower glucose by about 3 mmol/L

To use an ISF:

• (Current Blood Glucose – target) / ISF= units to give to correct high glucose reading
• e.g. If current BG 13 mmol/L , ISF is 2 and target is 7 mmol then:
13 mmol/L - 7 mmol/L  = 6 / ISF 2 = 3 units for correction

Related:

## Insulin to Carb Ratio (ICR)

• Method 1: Divide grams of usable carbohydrate eaten for a meal by bolus dose (units) per same meal to determine the carb part of the ICR
e.g. 70 g carb eaten / 5 units rapid = 14. So ICR = 1:14
Therefore, 1 unit of bolus insulin is given for every 14 g usable carb eaten

• Method 2: The 500 rule (500/TDD)
e.g. 500 / Total Daily Dose of insulin of 50 units = 10. So ICR = 1:10
Therefore, 1 unit of bolus insulin is given for every 10 g usable carb eaten