The Details of Insulin Doses

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When your child takes insulin (or you do), the objective is to duplicate the secretion of insulin by the normal pancreas. This secretion has two parts:

^ Under normal circumstances, there's usually a small amount of insulin called the basal secretion circulating in the blood at all times. This amount can be duplicated in a patient with T1DM by taking either long-acting glargine or detemir insulin. (The other way of getting a small amount of insulin constantly is with an insulin pump, a relatively new technique that I describe in Chapter 11.)

^ The pancreas secretes a larger amount of insulin at the time of the meals called the bolus secretion. This amount is duplicated by taking rapid-acting insulin (like aspart, glulisine, or lispro) just before the meal or regular insulin 30 minutes before meals. These days, the convenience of taking insulin just at the time your child is eating results in more frequent use of rapid-acting insulin.

Insulin is manufactured in strengths of 100 units per milliliter. The first time a patient takes insulin, the dosage is based upon a calculated total daily dose consisting of a basal dose and a bolus dose. Your child's doctor will make this determination, but he'll usually follow these steps:

1. Multiply the weight of the patient in kilograms by 0.3.

For example, a 35-kg patient requires 10.5 units of insulin per day, or approximately 10 units.

2. Divide the total daily dose into the basal dose and the bolus doses by simply dividing it in half.

So 5 units is used as the basal dose and 5 units as the bolus dose.

Your child takes the basal dose and the bolus dose at different times of day.

^ The basal dose is taken once or is sometimes split into two times a day, usually in the morning and/or at bedtime. I like to divide the basal dose into a large number of units in the morning and a few units at bedtime. In this case, I would use 4 units in the morning and 1 unit at night.

^ The bolus dose is taken before meals. It's divided up so that 40 percent is taken before breakfast, 20 percent before lunch, and 40 percent before supper. In this case, that would be 2 units, 1 unit, and 2 units.

The final determination of the insulin dose your child (or you) takes at any given time is usually based upon trial and error. Your child takes a specific dose of insulin and you check his blood glucose for the result (see Chapter 7 for full details on measuring blood glucose). If the glucose is high, he takes an extra unit next time. If the glucose is low, you reduce the insulin dose by a unit next time. A calculation like the one in the preceding list is approximate but a good starting point. After the initial dose is determined, it can be adjusted in order to achieve the levels of blood glucose shown in Table 10-3. These levels are for children and adults.

Table 10-3 Goals of Insulin Therapy


Ideal Glucose

Acceptable Glucose

Level (mg/dl)

Level (mg/dl)

Before meals



1 hour after meals



2 hours after meals



In the following sections, I explain the considerations you should make when calculating the bolus and basal doses for yourself or your child.

The dosing information that I present in this chapter is approximate; no matter what type of insulin you or your child takes, be sure to get a dosing plan from your doctor and ask questions.

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