3. Bedtime NPH plus MDI
4. Long-acting insulin plus MDI or basic mechanical pump
5. Long-acting insulin and bedtime NPH plus MDI
6. Full-feature insulin pump therapy
7. Hybrid closed-loop systems
Table 6-1
Total Daily Insulin Requirements (Units per Kilogram Body Weight)
to convert pounds to kilograms, multiply pounds by 0.454
Age Activity Level
: Inactive
Young Children: 0.60−1.2
Adolescents: 0.80−2.0
Adults: 0.60−1.2
Older Adults: 0.40−1.0
Age Activity Level
: Moderately Active
Young Children: 0.50−1.0
Adolescents: 0.75−1.50
Adults: 0.50−1.0
Older Adults: 0.35−0.80
Age Activity Level
: Very Active
Young Children: 0.40−0.80
Adolescents: 0.60−1.2
Adults: 0.40−0.80
Older Adults: 0.30−0.70
Table 6-2
Daily BASAL Insulin Requirements (Units per Kilogram Body Weight) to convert pounds to kilograms, multiply pounds by 0.454
Age Activity Level
: Inactive
Young Children: 0.25−0.60
Adolescents: 0.30−1.0
Adults: 0.25−0.60
Older Adults: 0.20−0.50
Age Activity Level
: Moderately Active
Young Children: 0.20−0.50
Adolescents: 0.30−0.70
Adults: 0.20−0.50
Older Adults: 0.15−0.40
Age Activity Level
: Very Active
Young Children: 0.15−0.40
Adolescents: 0.25−0.60
Adults: 0.15−0.40
Older Adults: 0.10−0.35
Table 6-3
Larry
Bedtime: 130 mg/dl (7.2 mmol/l)
Mid-Sleep: 190 mg/dl (11.1 mmol/l)
Wake-Up: 200 mg/dl (11.1 mmol/l)
Larry’s Brother Dary|
Bedtime: 130 mg/dl (7.2 mmol/l)
Mid-Sleep: 160 mg/dl (8.9 mmol/l)
Wake-Up: 200 mg/dl (11.1 mmol/l)
Larry’s Other Brother Darry|
Bedtime: 130 mg/dl (7.2 mmol/l)
Mid-Sleep: 65 mg/dl (3.6 mmol/l)
Wake-Up: 200 mg/dl (11.1 mmol/l)
Table 6-4. Example of a Basal Testing Schedule
Test: Overnight
Eat and bolus no later than: 7 p.m. (eat dinner, then skip evening snacks)
If using fingersticks, check blood sugar at: 11 p.m., 1 a.m., 3 a.m., 5 a.m., 7 a.m.
If using CGM, evaluate data from: 11 p.m. to 7 a.m.
Okay to eat and bolus again after: 7 a.m.
Test: Morning
Eat and bolus no later than: 3 a.m. (have a bedtime snack, then skip breakfast)
If using fingersticks, check blood sugar at: 7 a.m., 9 a.m., 11 a.m., 1 p.m.
If using CGM, evaluate data from: 7 a.m. to 1 p.m.
Okay to eat and bolus again after: 12 noon
Test: Afternoon
Eat and bolus no later than: 9 a.m. (have breakfast, then skip lunch and afternoon snacks)
If using fingersticks, check blood sugar at: 1 p.m., 3 p.m., 5 p.m., 6 p.m.
If using CGM, evaluate data from: 1 p.m. to 6 p.m.
Okay to eat and bolus again after: 6 p.m.
Test: Evening
Eat and bolus no later than: 2 p.m. (have a late lunch, then skip afternoon snacks and have a late dinner)
If using fingersticks, check blood sugar at: 6 p.m., 8 p.m., 10 p.m., 11 p.m.
If using CGM, evaluate data from: 6 p.m. to 11 p.m.
Okay to eat and bolus again after: 11 p.m.
Table 6-5. Suggested Magnitude of Basal Insulin Adjustments
Current Basal Level (units/hour)
Blood Sugar Change During Test: : Modest (30, 60 mg/dl; 1.7, 3.4 mmol/l): 0.0, 0.35: 0.025 or 0.05
Blood Sugar Change During Test: : Modest (30, 60 mg/dl; 1.7, 3.4 mmol/l): 0.4, 1.0: 0.10
Blood Sugar Change During Test: : Modest (30, 60 mg/dl; 1.7, 3.4 mmol/l): >1.0: 0.2
Blood Sugar Change During Test: : Large (>60 mg/dl; >3.4 mmol/l): 0.0, 0.35: 0.05 or 0.10
Blood Sugar Change During Test: : Large (>60 mg/dl; >3.4 mmol/l): 0.4, 1.0: 0.20
Blood Sugar Change During Test: : Large (>60 mg/dl; >3.4 mmol/l): >1.0: 0.3 or 0.4
Table 7-1. Estimating Your I:C Ratio from Total Daily Insulin
Total Daily Units of Insulin (Basal + Bolus) : 8−11
Estimated I:C Ratio : 1:50
Total Daily Units of Insulin (Basal + Bolus) : 12-14
Estimated I:C Ratio : 1:40
Total Daily Units of Insulin (Basal + Bolus) : 15-18
Estimated I:C Ratio : 1:30
Total Daily Units of Insulin (Basal + Bolus) : 19-21
Estimated I:C Ratio : 1:25
Total Daily Units of Insulin (Basal + Bolus) : 22-27
Estimated I:C Ratio : 1:20
Total Daily Units of Insulin (Basal + Bolus) : 28-35
Estimated I:C Ratio : 1:15
Total Daily Units of Insulin (Basal + Bolus) : 36-45
Estimated I:C Ratio : 1:12
Total Daily Units of Insulin (Basal + Bolus) : 46-55
Estimated I:C Ratio : 1:10
Total Daily Units of Insulin (Basal + Bolus) : 56-65
Estimated I:C Ratio : 1:8
Total Daily Units of Insulin (Basal + Bolus) : 66-80
Estimated I:C Ratio : 1:7
Total Daily Units of Insulin (Basal + Bolus) : 81-120
Estimated I:C Ratio : 1:5
Total Daily Units of Insulin (Basal + Bolus) : 121-160
Estimated I:C Ratio : 1:4
Total Daily Units of Insulin (Basal + Bolus) : >160
Estimated I:C Ratio : 1:3
Table 7-2. Determining I:C Ratio from Weight
Weight (lbs): <40
Weight (kg): <18
Estimated I:C Ratio: 1:50
Weight (lbs): 41−60
Weight (kg): 18−26
Estimated I:C Ratio: 1:35
Weight (lbs): 61−80
Weight (kg): 27−36
Estimated I:C Ratio: 1:25
Weight (lbs): 81−100
Weight (kg): 37−45
Estimated I:C Ratio: 1:20
Weight (lbs): 101−120
Weight (kg): 46−54
Estimated I:C Ratio: 1:17
Weight (lbs): 121−140
Weight (kg): 55−64
Estimated I:C Ratio: 1:14
Weight (lbs): 141−170
Weight (kg): 65−77
Estimated I:C Ratio: 1:12
Weight (lbs): 171−200
Weight (kg): 78−91
Estimated I:C Ratio: 1:10
Weight (lbs): 201−230
Weight (kg): 92−104
Estimated I:C Ratio: 1:8
Weight (lbs): 231−270
Weight (kg): 105−123
Estimated I:C Ratio: 1:7
Weight (lbs): 271−320
Weight (kg): 124−145
Estimated I:C Ratio: 1:6
Weight (lbs): >320
Weight (kg): >145
Estimated I:C Ratio: 1:5
Table 7-3
Sunday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 145 (8.1)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 97 (5.4)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 67 (3.7)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 113 (6.3)
Monday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 188 (10.5)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 115 (6.4)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 104 (5.8)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 109 (6.1)
Tuesday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 205 (11.4)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 89 (4.9)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 58 (3.2)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 88 (4.8)
Wednesday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 175 (9.7)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 73 (4.1)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 42 (2.3)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 255 (14.2)
Thursday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 169 (9.4)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 146 (8.1)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 117 (6.5)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 122 (6.8)
Friday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 222 (12.3)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 128 (7.1)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): (forgot)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 202 (11.2)
Saturday
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 190 (10.6)
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 105 (5.8)
Pre-Dinner Blood Sugar in mg/dl (mmol/l): 61 (3.3)
Pre-Bedtime Snack Blood Sugar in mg/ dl (mmol/l): 136 (7.6)
Table 7-4. Data Log
Date: 6/1
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 175 (9.7)
Carbs (grams): 50
Bolus Insulin (units): 6.5
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 101 (5.6)
Conclusion About I:C Ratio: 1:8 makes BG drop
Date: 6/2
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 83 (4.6)
Carbs (grams): 50
Bolus Insulin (units): 4.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 78 (4.3)
Conclusion About I:C Ratio: 1:12 held BG steady
Date: 6/3
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 62 (3.4)
Carbs (grams): 75
Bolus Insulin (units): 5.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 226 (12.5)
Conclusion About I:C Ratio: Don’t count, low to start
Date: 6/4
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 151 (8.4)
Carbs (grams): 50
Bolus Insulin (units): 6.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 93 (5.2)
Conclusion About I:C Ratio: 1:8 makes BG drop
Date: 6/5
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 210 (11.6)
Carbs (grams): 40
Bolus Insulin (units): 6.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 113 (6.3)
Conclusion About I:C Ratio: 1:7 makes BG drop a lot
Date: 6/6
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 75 (4.2)
Carbs (grams): 75
Bolus Insulin (units): 5.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 180 (10.0)
Conclusion About I:C Ratio: 1:15 makes BG rise
Date: 6/7
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 123 (6.8)
Carbs (grams): 50
Bolus Insulin (units): 5.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 86 (4.7)
Conclusion About I:C Ratio: 1:10 makes BG drop a bit
Date: 6/8
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 99 (5.5)
Carbs (grams): 90
Bolus Insulin (units): 7.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 52 (2.8)
Conclusion About I:C Ratio: 1:14 makes BG drop Date: 6/9
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 97 (5.4)
Carbs (grams): 30
Bolus Insulin (units): 2.5
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 114 (6.3)
Conclusion About I:C Ratio: 1:12 held BG steady
Date: 6/10
Pre-Breakfast Blood Sugar in mg/dl (mmol/l): 154 (8.5)
Carbs (grams): 65
Bolus Insulin (units): 3.0
Pre-Lunch Blood Sugar in mg/dl (mmol/l): 274 (15.2)
Conclusion About I:C Ratio: 1:20 makes BG rise a lot
Table 7-5. Estimating the Daytime Sensitivity Factor Based on Total Daily Insulin
Average Total Daily Insulin (Basal + Bolus units): 5
Approximate Sensitivity Factor (mg/dl): 320, 360
Approximate Sensitivity Factor (mmol/l): 18, 20
Average Total Daily Insulin (Basal + Bolus units): 7
Approximate Sensitivity Factor (mg/dl): 220, 260
Approximate Sensitivity Factor (mmol/l): 12, 14
Average Total Daily Insulin (Basal + Bolus units): 10
Approximate Sensitivity Factor (mg/dl): 155, 185
Approximate Sensitivity Factor (mmol/l): 8.6, 10.3
Average Total Daily Insulin (Basal + Bolus units): 12
Approximate Sensitivity Factor (mg/dl): 125, 155
Approximate Sensitivity Factor (mmol/l): 6.9, 8.6
Average Total Daily Insulin (Basal + Bolus units): 15
Approximate Sensitivity Factor (mg/dl): 95, 125
Approximate Sensitivity Factor (mmol/l): 5.3, 6.9
Average Total Daily Insulin (Basal + Bolus units): 18
Approximate Sensitivity Factor (mg/dl): 80, 110
Approximate Sensitivity Factor (mmol/l): 4.4, 6.1
Average Total Daily Insulin (Basal + Bolus units): 20
Approximate Sensitivity Factor (mg/dl): 70, 100
Approximate Sensitivity Factor (mmol/l): 3.9, 5.5
Average Total Daily Insulin (Basal + Bolus units): 25
Approximate Sensitivity Factor (mg/dl): 60, 80
Approximate Sensitivity Factor (mmol/l): 3.3, 4.4
Average Total Daily Insulin (Basal + Bolus units): 30
Approximate Sensitivity Factor (mg/dl): 50, 70
Approximate Sensitivity Factor (mmol/l): 2.8, 3.9
Average Total Daily Insulin (Basal + Bolus units): 35
Approximate Sensitivity Factor (mg/dl): 40, 60
Approximate Sensitivity Factor (mmol/l): 2.2, 3.3
Average Total Daily Insulin (Basal + Bolus units): 40
Approximate Sensitivity Factor (mg/dl): 35, 50
Approximate Sensitivity Factor (mmol/l): 2.0, 2.8
Average Total Daily Insulin (Basal + Bolus units): 45
Approximate Sensitivity Factor (mg/dl): 30, 45
Approximate Sensitivity Factor (mmol/l): 1.7, 2.5
Average Total Daily Insulin (Basal + Bolus units): 50
Approximate Sensitivity Factor (mg/dl): 30, 40
Approximate Sensitivity Factor (mmol/l): 1.7, 2.2
Average Total Daily Insulin (Basal + Bolus units): 60
Approximate Sensitivity Factor (mg/dl): 25, 35
Approximate Sensitivity Factor (mmol/l): 1.4, 2.0
Average Total Daily Insulin (Basal + Bolus units): 70
Approximate Sensitivity Factor (mg/dl): 20, 30
Approximate Sensitivity Factor (mmol/l): 1.1, 1.7
Average Total Daily Insulin (Basal + Bolus units): 80
Approximate Sensitivity Factor (mg/dl): 20, 25
