ISF Determination

What is a ISF?
The insulin sensitivity factor (unit: (mg/dl)/U or (mmol/dl)/U) says how
sensitive we react to insulin, so how much our glucose level will come down
per unit of insulin . For instance, ISF = 30 (mg/dl)/U means, per unit of insulin
our glucose level goes down 30 mg/dl. ISF = 30/18 = 1.7 (mmol/dl)/U
Unfortunately, it is not one fixed number we can count on (count with):
* can vary between times of day => use circadian pattern
See AndroidAPS Users / Files / ..circadian … Duesterhoff.xls:
https://www.facebook.com/groups/AndroidAPSUsers/permalink/2869638923257506/

* will vary between days e.g. when hormones play into it => Autosense

* can also fluctuate within shorter episodes, e.g. @ stress, or @ high glucose
values because of insulin resistance after a fatty meal

Estimates based on TDD

Similar, from study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454102/

ISF was determined with the so-called 1700 rule,27 that is,

ISF=1700 / TDI
where TDI is the total daily insulin, determined for each virtual patient, using optimal CR and
basal infusion rate, and assuming an average diet of 180 g of CHO for adolescents and adults
and 135 g for children.

Signs for a wrong ISF when looping

If your ISF is too strong (in other words the actual number is too low compared to reality of
how strong the insulin is) in closed-looping, one of the most common symptoms you’ll see is
a roller coaster of BGs where the temp basals are cycling between zero and high temping.

If ISF is too weak, the glucose is not corrected down to target (or this happens only extremely
slow).

Determination of ISF
.. should be done at times of day when loop must correct high values

Insulin sensitivity factor (ISF) is the next logical setting to test. If you’ve just done the basal
test and gotten steady BGs with an open loop…try taking a well defined amount of rapidly
acting carbs (enough that will bring you roughly 100 mg/dl higher).

Wait for your BGs to be steady at the significantly higher BG..

… and give a safe correction that you think will get you close to target.

Watch the resulting BG drop over the next 2-3 hours. You should see BGs come to a steady
level again. How much did the BG drop? How many units of insulin did you use?

Divide the two numbers and you will have your ISF:

For example, if your BG dropped 80 mg/dl with 2 units of insulin (adult example!) , your
ISF is approximately 40 (mg/dl)/U.

~ see: : http://seemycgm.com/2017/10/29/fine-tuning-settings/

Determination via Autotune: Limited value / see discussion at IC factor / or search

„Autotune“ in AAPS User Facebook
Circadian pattern of ISF

See AndroidAPS Users / Files / ..circadian … Duesterhoff.xls:

https://www.facebook.com/groups/AndroidAPSUsers/permalink/2869638923257506/

Example

Relation to CRR

CRR = ISF/IC (mg/dl)/g

The carb rise ratio (also called CSF, carb sensitivity factor) is actually quite easy
to determine (maybe easier than the IC, which requires 3 hours with underlying
stable glucose and correct basal rate):
Drink sweet beverage with x g of carbs, and watch how much (mg/dl) glucose
rises.

=> ISF (mg/dl drop per U) / CRR (mg/dl rise per g carb) = IC (g carb / U)

(Likewise of course in the mmol world)