Master these 5 steps to easily calculate and adjust insulin dosage

Insulin injection is one of the important means of treating diabetes. However, in the early stage of insulin treatment for diabetic patients, the dosage is not fixed each time and needs to be adjusted at any time according to the patient's diet and condition. Because only by accurately calculating the insulin dosage can blood sugar be fully controlled and the risk of hypoglycemia be reduced.

So, how should the insulin injection dosage be calculated? Today, Tangtang will talk to you about the calculation of insulin injection dosage~

Five-step method for calculating and adjusting insulin dosage

The first step is to determine the daily dose

The daily dosage of insulin for the first time should be as follows:

Fasting blood glucose (mmol/L) × 1.8
Body weight (kg) × 0.3~0.51. Patients who use insulin for the first time should inject insulin 3 times a day. The method of "dividing the daily amount by 3, subtracting 2 at noon and adding it to the morning" is suitable for distribution. For example, if you use 30 U of short-acting insulin daily, divided by 3 is 10 U, subtract 2 U at noon and add it before breakfast, that is, 12 U in the morning, 8 U at noon, and 10 U in the evening. After blood sugar reaches the standard, switch to premixed insulin and inject it twice before breakfast and dinner.

2. Inject premixed insulin twice a day: 2/3 before breakfast and 1/3 before dinner.

3. Inject insulin once a day, take hypoglycemic drugs orally before 3 meals during the day, and add a long-acting or intermediate-acting insulin before going to bed at 0.2 U per kilogram of body weight.

The second step is to determine the starting amount of the basic dose

Depending on the total daily insulin intake, the ratio of basal/meal insulin dosage varies from person to person. Usually a 50/50 ratio is used, but some people may need a 40/60 ratio.

Since blood sugar levels are not up to standard or hypoglycemia occurs, the amount of insulin at this time should be adjusted according to fasting blood sugar. After starting treatment, basal insulin can be adjusted every 2 to 3 days until fasting blood sugar reaches the control target. If fasting blood sugar has been adjusted to 5.0 to 7.0 mmol/L, it can be left unchanged; when fasting blood sugar is 3.0 to 5.0 mmol/L, insulin should be reduced by 2 to 3 U or injected after meals; if fasting blood sugar is > 7.0 mmol/L, add 1 U of insulin for every 1.4 mmol/L increase.

Step 3: Calculate the meal dose

Mealtime insulin dose = 0.1 U/kg/meal (e.g. a 70 kg person might need a mealtime dose of 7 U of rapid-acting insulin)

Clarify the time of insulin injection: rapid-acting insulin should be injected 15 minutes before meals. If blood sugar is already lower than 4.5 mmol/L before meals, then inject insulin before taking the first bite of food.

Step 4: Regulate postprandial blood sugar levels

If blood sugar is higher than 10.0 mmol/L 2 hours after a meal, 1 U of insulin should be added for every 2.0 mmol/L increase, but the amount added at one time should not exceed 4 U. In addition, it should be noted that when intravenous insulin is used in ketoacidosis, the rate of blood sugar decrease should not exceed 5.6 mmol/L per hour, otherwise it is easy to cause cerebral edema.

Step 5: Adjust the dosage of mixed insulin

Patients with type 2 diabetes who inject mixed insulin in the morning and evening:

If the patient's blood sugar is high before lunch, it indicates that the dose of short-acting insulin in the mixed insulin he is using is insufficient.

If the patient's blood sugar level is high before dinner, it indicates that the dose of intermediate-acting insulin in the mixed insulin he is using is insufficient.

If the patient's blood sugar is high before going to bed, it indicates that the dose of short-acting insulin in the mixed insulin he is using is insufficient.

If the patient's blood sugar is high in the morning, it means that the dosage of long-acting and intermediate-acting insulin in the mixed insulin he uses is insufficient.

Patients using mixed insulin can adjust the insulin dosage appropriately according to the above principles.

In short, insulin therapy emphasizes individualization. How to "control" insulin is an art. There is a lot of knowledge and skills involved. We must abide by principles while not being too dogmatic. Only in this way can we achieve a perfect unity of efficacy and safety. This is the highest level that clinical treatment strives for.

References: [1] Fu Peng. A brief discussion on the basic use of insulin [J]. Chinese Community Physician, 2008(14):24.

[2] Li Changyu, Huang Xuguang. How to calculate and adjust the dosage of insulin for patients with type 2 diabetes [J]. Seeking Medicine, 2009(12):14-15.

[3] Chen Qinda. How to estimate insulin dosage[J]. Family Medicine, 2009(11):15-15.

[4] Zhang Wei, Liao Lin. Discussion on dosage adjustment of premixed insulin analogs in the treatment of type 2 diabetes[J]. Chinese Journal of Diabetes, 2015, 000(006):398-400.

[5] Sun Hong. Dosage and estimation of insulin in patients with type 2 diabetes mellitus[J]. Science Popularization (Science Education), 2016, 000(010):182.