Titrate noninsulin agent while decreasing premeal insulin dose with goal of stopping premeal insulin. If pre-lunch average is not in desired range, adjust pre-breakfast dose If pre-dinner average is not in desired range, adjust pre-lunch dose If pre-bedtime snack average is not in desired range, adjust pre-dinner dose. Divide by the patient's total daily dose of insulin 2.
Step 2 - Monitor blood sugars Check fasting blood sugar in the morning and predinner blood sugar in the evening on a daily basis. Rapid-acting and short-acting insulin When converting between rapid-acting and short-acting insulins, the dose typically remains the same Rapid-acting insulins act quicker within 10 - 30 minutes than short-acting insulins within 30 - 60 minutes , therefore, the timing of the dose should be adjusted Rapid-acting insulins have a shorter duration of action than short-acting insulins 3 - 5 hours vs 6 - 8 hours.
Because of this, patients switching to rapid-acting insulins from short-acting insulins may require more basal insulin to maintain blood sugar control, and vice versa. Conversions for inhaled insulin are discussed here - inhaled insulin dosing. See converting from long-acting insulin to NPH for more. When using your insulin-to-carb ratio, you divide the total grams of carbohydrate by the ratio amount.
Your ratio may be the same or different at each meal. Using an insulin-to-carb ratio of gives you more insulin than if you use a ratio of You will have to do some math to figure out how to change your ratio. The diabetes nurses will teach you how to do this. It will not be perfect at first. It will take some time. Home » Health Topics » What is diabetes? Insulin-to-carb ratios to calculate meal insulin doses with type 1 diabetes.
Use an insulin-to-carb ratio if you: Are not sure your very young child will eat all the carbohydrate in the meal Are not hungry Do not like some foods served with a meal Are eating a meal with a lot of carbohydrate Are eating a low carbohydrate meal Need or want a larger snack The insulin-to-carb ratio means you will take 1 unit of insulin for a certain amount of carbohydrate.
To use an insulin-to-carb ratio, you need to: Plan ahead and eat all of your meal. Take your rapid-acting insulin 15 minutes before you eat. The only time it is okay to take the rapid-acting insulin after eating is for very young children who may not eat everything.
Individuals who are on this regimen are unable to adjust their insulin, but carb counting can be applied to maintain similar amounts at meals. Those who are on this regimen, are able to adjust their injection of bolus insulin e. Humalog or Novorapid at each meal time. The amount of bolus insulin taken is directly related to the amount of carbohydrate consumed. As you must be able to accurately calculate the amount of carbohydrate you eat and drink before adjusting your bolus dose, a carbohydrate log can help you demonstrate this.
It can also be useful to record a detailed diary which outlines carbohydrate eaten, blood glucose, activity, bolus and basal insulin. BERTIE is an online resource that provides additional information on the key principles of carb counting and insulin dose adjustment. It has been developed by the Bournemouth Diabetes Team.
Carbohydrate counting and insulin dose adjustment is a complex process. Before implementing this strategy, it is important to have the support and guidance of your diabetes care team. Lovely lunches. Main meals. Breakfast matters. Guilt free snacking. Fruit and vegetables. Glycaemic Index. Insulin dose adjustment. Carbohydrate counting. Read more.
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