Estimation of initial insulin dosage: (0.3-0.8) × body weight (kg), 0.4 – 0.5 is the cut-off value
When starting insulin therapy for diabetic patients, always use short-acting insulin. Moreover, the initial dosage must be estimated according to the following methods on the basis of relatively stable diet and exercise, and then adjusted according to the condition monitoring results.
1. Estimation according to fasting blood sugar.
Daily insulin dosage (μ) = [fasting blood glucose (mmol/L)*18-100]*10*weight (kg)*0.6÷1000÷2
100 is the normal value of blood glucose (mg/dl);
*18 is the coefficient of conversion of mmol to mg/dl;
x 10 is the amount of higher than normal blood glucose per liter of body fluid;
x 0.6 is the amount of systemic body fluid for 60%;
÷1000 is the conversion of blood glucose mg to grams;
÷ 2 is 2 grams of blood glucose using 1μ insulin.
To avoid hypoglycemia, the actual use of its 1/2 – 1/3 amount.
2. Estimation by 24-hour urine glucose.
Those with mild disease, no diabetic nephropathy and normal renal sugar threshold, give 1μ insulin for every 2 grams of urine sugar.
3.According to body weight.
High blood glucose, severe disease, 0.5 – 0.8μ/kg; mild disease, 0.4 – 0.5μ/kg; severe disease, stress state, should not exceed 1.0μ/kg.
4. Estimated by 4 urine glucose.
No diabetic nephropathy, renal sugar threshold is basically normal, according to each meal before the urine sugar qualitative “+” how much to estimate. Generally a “+” requires 4μ insulin.
5. Comprehensive estimation.
There are many factors affecting the role of insulin in the body, and individual differences are large, so the above calculation may not be in line with the actual, so the condition, blood sugar and urine sugar should be integrated, and a certain safe amount should be given first, and then gradually adjusted according to changes in the condition.
(B) How to allocate insulin dosage
According to the above estimation, insulin should be injected 15-30 minutes before three meals daily, and the dosage should be distributed as before breakfast > before dinner > before lunch. Because the body antagonistic insulin hormone secretion before breakfast, so insulin dosage should be larger; and generally short-acting insulin peak time 2 – 4 hours, so the dosage before lunch is the smallest; most patients no longer use insulin before bedtime, until the next morning, so the dosage before dinner is larger than before lunch. If you still use it once before bedtime, the amount before dinner should be reduced, and the amount before bedtime is even less to prevent hypoglycemia at night.
(C) How to adjust insulin dosage
After the initial estimated dosage is observed for 2 – 3 days, the dosage will be further adjusted according to the condition, blood sugar and urine sugar.
1. Qualitative adjustment according to 4 times of urine glucose: Only for patients who have no condition to measure blood glucose and have normal renal glucose threshold. Adjustment according to 4 times urine sugar qualitative in the first 3 – 4 days: insulin dosage before breakfast is based on urine sugar before lunch, insulin dosage before lunch is based on urine sugar before dinner, insulin dosage before dinner is based on urine before bedtime or the next morning (including morning urine of the same day).
2. Adjustment according to blood sugar: diabetic patients, especially type I diabetes and patients with abnormal renal sugar threshold, should adjust insulin dosage according to the blood sugar value before three meals and before bedtime.
How to calculate the dose when changing from short-acting insulin to 30R? The total daily dose remains unchanged, putting 2/3 of the total amount before breakfast and 1/3 of the amount before dinner.
My principle is that the initial dose of short-acting insulin for diabetic patients is 10u in the morning, 6u in the afternoon, and 8u in the evening for subcutaneous injection 15 minutes before meals, and then increase or decrease the insulin dosage according to the blood glucose situation. The amount of dinner and bedtime can be added together and reduced by 2-6u as the amount of subcutaneous injection before dinner. Then make adjustments, this is my experience for your reference
When starting insulin therapy for diabetic patients, always use short-acting insulin. Moreover, the initial dosage must be estimated according to the following methods on the basis of relatively stable diet and exercise, and then adjusted according to the results of disease monitoring.
1. Estimation according to fasting blood sugar.
Daily insulin dosage (μ) = [fasting blood glucose (mmol/L)*18-100]*10*weight (kg)*0.6÷1000÷2
100 is the normal value of blood glucose (mg/dl);
*18 is the coefficient of conversion of mmol to mg/dl;
x10 is the amount of higher than normal blood glucose per liter of body fluid;
x0.6 is the amount of whole body fluids for 60%;
÷1000 is the conversion of blood glucose mg to grams;
÷2 is 2 grams of blood glucose using 1μ insulin.
Simplified formula: daily insulin dosage (μ) = (FBS grams – 0.1) × 2 to 3 × body weight Kg
Example 1 FBS 300mg/dl (0.3g), weight 50Kg, calculated as a daily amount of 20 to 30 units.
In order to avoid hypoglycemia, 1/2 – 1/3 of the actual amount should be used.
Rough formula.
Fasting blood glucose mmol/L×1.8=daily insulin amount.
Fasting blood glucose mg/dl ÷ 10 = daily insulin amount.
2.Estimated by 24-hour urine sugar: Those with mild disease, no diabetic nephropathy and normal renal sugar threshold are given 1μ insulin per 2g urine sugar.
3.According to body weight: 0.5–0.8μ/kg for high glucose and severe disease; 0.4–0.5μ/kg for mild disease; no more than 1.0μ/kg for severe disease and stress condition.
4.Estimated by 4 urine sugar: no diabetic nephropathy, renal sugar threshold is basically normal, estimated by the number of urine sugar qualitative “+” before each meal. Generally a “+” requires 4μ insulin.
5. Comprehensive estimation: There are many factors affecting insulin action in the body and individual differences, so the above calculation may not be in line with the actual situation, therefore, the condition, blood glucose and urine sugar should be integrated and a certain safe amount should be given first, and then gradually adjusted according to the changes in the condition.
(B) How to allocate insulin dosage
According to the above estimation, insulin should be injected 15-30 minutes before three meals daily, and the dosage should be distributed as before breakfast > before dinner > before lunch. Because the body antagonistic insulin hormone secretion before breakfast, so insulin dosage should be larger; and generally short-acting insulin peak time 2 – 4 hours, so the dosage before lunch is the smallest; most patients no longer use insulin before bedtime, until the next morning, so the dosage before dinner is larger than before lunch. If you still use it once before bedtime, the amount before dinner should be reduced, and the amount before bedtime is even less to prevent hypoglycemia at night.
(C) How to adjust insulin dosage
After the initial estimated dosage is observed for 2 – 3 days, the dosage will be further adjusted according to the condition, blood sugar and urine sugar.
1. Qualitative adjustment according to 4 times of urine glucose: Only for patients who have no condition to measure blood glucose and have normal renal glucose threshold. Adjustment according to 4 times urine sugar qualitative in the first 3 – 4 days: insulin dosage before breakfast is based on urine sugar before lunch, insulin dosage before lunch is based on urine sugar before dinner, insulin dosage before dinner is based on urine before bedtime or the next morning (including morning urine of the same day).
2. Adjustment according to blood sugar: diabetic patients, especially type I diabetes and patients with abnormal renal sugar threshold, should adjust insulin dosage according to the blood sugar value before three meals and before bedtime.
After fasting blood sugar >7mmol/L, for every 1mmol/L increase in blood sugar, add 1.4 units of insulin; 2 hours after meals, blood sugar >10mmol/L, for every 2mmol/L increase in blood sugar, add 1 unit of insulin. One “+” of urine sugar increases insulin by 2 to 4 units.
Dose calculation when changing from short-acting insulin to 30R: the total daily dose remains unchanged, and 2/3 of the total amount is put before breakfast and 1/3 amount before dinner.