I love the technology in my life with diabetes. My blood glucose (BG) meter, continuous glucose monitor and insulin pump allow me to move about my day with ease and less mental taxation.
I have become so reliant on my pump to automatically adjust and arrange my doses of insulin that I sometimes wonder what would happen if it didn’t work.
Batteries die, things get dropped and sometimes I run out of supplies.
Would I know what to do? Could I manage it manually?
Of course, my first call would be to my doctor’s office to be sure I was following the right directions.
Manually calculating the various rates that a diabetic needs can be difficult to remember when we get out of practice. Some of the terms and formulas below might help.
A great resource for remembering how to calculate these can be found in the book, The Diabetes and Insulin Pump Initiation Handbook, by Dino Pierce RD, CDE, CPT, CFT.
The Total Daily Dose (TDD) is the total amount of insulin injected daily. If you give daily injections this should include both long and short acting insulin dosages.
If you use an insulin pump, this should include both the basal rate as well as any additional boluses given during the day. Pump users only use rapid acting insulin, but both rates should be included.
The basal rate is the continuous delivery of insulin used to keep BG levels stable throughout a 24-hour period. Basal rates usually average 40-60 percent of the TDD, but your doctor will determine the best number for you.
To determine an initial hourly basal rate, multiply the TDD by .4 and divide this number by 24. This number represents how much insulin should be administered over each one hour duration.
A bolus is an additional amount of insulin given to treat an elevated BG due to a meal, or a high blood sugar in general. In order to give a bolus prior to a meal, you need to know your insulin to carbohydrate ratio.
According to Marina Martin, an Ehow.com contributor, “To calculate initial Insulin to Carbohydrate ratios, divide 450 by your TDD. This represents the amount you should inject for a specific number of grams of carbohydrate that you eat”.
As always, any changes that you incorporate into your diabetes regimen should be approved by your physician. If there is a case of your pump breaking, then increase the number of BG tests throughout the day.
If you have unexplained hypoglycemia for two or more consecutive days, decrease by .1 units. For sustained hyperglycemia, increase by .1 units until stabilized.
By Marianne Tetlow, “The Diabetes Coach”
The Diabetes Coach is a comprehensive resource and consulting group for individuals or families with a loved one dealing with diabetes.
“Helping You To Move Forward While Managing the Ups and Downs”
“How to determine a basal rate on an insulin pump. Ehow.com. Web. June 4, 2012.
The Diabetes and Insulin Pump Initiation Handbook: A guide for patients and clinicians, by Dino P. Pierce, RD, CDE, CPT, CFT 2011
Reviewed June 5, 2012
by Michele Blacksberg RN
Edited by Jody Smith