• COURSE NAME: Critical Care & Emergency

Nutrition
• COURSE CODE:SHS.514 lec.11
• CREDIT HOURS: 3hrS
• INSTRUCTOR: Saba Nadeem Dar

School of Health Sciences

University of Management and technology
Insulin calculation
 Characteristics of Insulin Action

• There are three characteristics that define types of

insulin.
• Onset: How long it takes for the insulin to start
lowering blood glucose
• Peak time: Time after injection when the insulin is the most
effective at lowering blood glucose
• Duration: How long the insulin keeps lowering blood glucose
 Types of Insulin
• Rapid-acting: 
• These include Apidra, Humalog, and Novolog. They have an onset in less than
15 minutes, peak in 30 to 90 minutes, and duration of two to four hours.
• Regular (short-acting): 

• These include Humulin R and Novolin R. They have an onset of a half an

hour, a peak of two to three hours, and duration of three to six hours.
• Intermediate-acting: These include Humulin N and Novolin N. They have an
onset of two to four hours, a peak at four to 12 hours, and duration of 12 to
18 hours.
• Long-acting: 

• These include Levemir and Lantus. They have an onset of several hours, minimal or no peak,

and a duration of 24 hours or more.

• Ultra long-acting: These include Toujeo. They have an onset of six hours, no peak, and a

duration of 36 hours.

• Combinations/pre-mixed: These combine intermediate-acting insulins with regular insulin

and are convenient for people who need to use both.

• Inhaled insulin: This became available in 2015 and is used in combination with long-acting

insulin. Afrezza has an onset of 12 to 15 minutes, a peak of 30 minutes, and duration of three

hours
 Background or basal insulin

• 40-50% of TDI
• Replace insulin overnight
• Dose is constant from day to day
  Bolus insulin
• 50-60% of the TDI dose

• For carbohydrate coverage (food) and high

blood sugar correction
 Bolus – Carbohydrate coverage
• The bolus dose for food coverage is prescribed
as an insulin to carbohydrate ratio.

• The insulin to carbohydrate ratio represents

how many grams of carbohydrate are covered
or disposed of by 1 unit of insulin.
 Carbohydrate coverage at a meal
• CHO insulin dose =
    Total grams of CHO in the meal
÷ grams of CHO disposed by 1 unit of insulin

• For Example #1, assume:

• You are going to eat 60 grams of carbohydrate for
lunch
• Your Insulin: CHO ratio is 1:10
Calculate?
You will need 6 units of rapid acting insulin to
cover the carbohydrate.
You are taking 125 grams of CHO in a meal
how many units of insulin are required
 Bolus – High blood sugar correction

• Also known as insulin sensitivity factor

• The bolus dose for high blood sugar correction

is defined as how much one unit of rapid-
acting insulin will drop the blood sugar.
 Example #2: High blood sugar correction
dose
• High blood sugar correction dose =
     Difference between actual blood sugar and
target blood sugar*
÷ correction factor.

• *Actual blood sugar minus target blood sugar

 For Example #2, assume:
• Pre-meal blood sugar target is 120 mg/dl.

• Your actual blood sugar before lunch is 220

mg/dl.
Calculate?
 you will need an additional 2 units of rapid acting insulin to
“correct” the blood sugar down to a target of 120 mg/dl.
 Total mealtime dose
• Finally, to get the total mealtime insulin dose,
add the CHO insulin dose together with the
high blood sugar correction insulin dose:
•    CHO Insulin Dose
+ High Blood Sugar Correction Dose
= Total Meal Insulin Dose
Calculate?
The total lunch insulin dose is 8 units of
rapid acting insulin.
 Total Daily Insulin Requirement
• The general calculation for the body’s daily insulin
requirement is:
•  Total Daily Insulin Requirement(in units of insulin)
= Weight in Pounds ÷ 4
• Alternatively, if you measure your body weight in
kilograms:
• Total Daily Insulin Requirement (in units of insulin)
= 0.55 X Total Weight in Kilograms
Assume you weigh 160 lbs.
Assume your weight is 70Kg
Calculate?
 40 units of insulin/day
38.5 units of insulin/day
 Basal/background insulin dose:
• Basal/background Insulin Dose
= 40-50% of Total Daily Insulin Dose
• Example
• Assume you weigh 160 pounds
• Your total daily insulin dose (TDI) = 160 lbs ÷ 4
= 40 units.
 In this example:
Basal/background insulin dose
= 50% of TDI (40 units) = 20 units
 The carbohydrate coverage ratio:
• 500 ÷ Total Daily Insulin Dose
= 1 unit insulin covers so many grams of
carbohydrate

• This can be calculated using the Rule of “500”:

Carbohydrate Bolus Calculation
• Example:
• Assume your total daily insulin dose (TDI)
= 200 lbs ÷ 4 = 50 units
• In this example:
• Carbohydrate coverage ratio
= 500 ÷ TDI (50 units)
= 1unit insulin/ 10 g CHO
The high blood sugar correction factor:

• Correction Factor = 1800 ÷Total Daily Insulin

Dose = 1 unit of insulin will reduce the blood
sugar so many mg/dl
• This can be calculated using the Rule of
“1800”.
• Example:
• Assume your total daily insulin dose(TDI) =
160 lbs ÷ 4 = 40 units
• In this example:
• Correction Factor
= 1800 ÷ TDI(40 units)
= 1 unit insulin will drop reduce the blood
sugar level by 45 mg/dl
 Case study
• B is a 52-year-old Caucasian woman who was
diagnosed with type 1 diabetes. She developed
hypertriglyceridemia 3 years later and
hypertension 9 years later. Other medical
problem includes obesity.
• Physical exam reveals a height of 64 inches, a
weight of 174 lb and a waist circumference of
40 inches. Blood pressure, well controlled is
104/70 mmHg.
• Laboratory results reveal a fasting lipid panel as follows:
total cholesterol 214 mg/dl, triglycerides 940 mg/dl,
direct HDL cholesterol 24 mg/dl, an invalid LDL cholesterol
unobtainable because of the hypertriglyceridemia, and a
free fatty acid of 1.1 mEq/l (normal range 0.1–0.6 mEq/l).
Hemoglobin A1c (A1C) is 10.5%, and fasting blood glucose
(FBG) is 314 mg/dl. When called to discuss the finding of
severe hypertriglyceridema, the patient commented that
she had previously had fasting triglycerides as high as
3,000 mg/dl.
• Calculate insulin requirement?
• Calculate ISF?
• Calculate I:C ratio?
• Design NG feeding?
• Select formula for NG feeding?
Thank you