What Is The 500 Rule In Diabetes

Should You Round Up Or Down

In most cases the total amount of insulin will need to be rounded to the next nearest full unit. This is because not many people with diabetes use insulin pen devices that can deliver insulin at half unit increments. But should the number be rounded up or down? Well, this depends on the sensor glucose or blood glucose level at the time. .

Generally speaking, if the BGL is high at the time it is usually recommended that you round up. But if the BGL is on the lower side it is worthwhile rounding down . You should also consider what the person will be doing during the following few hours. If they are going to be sitting around you may want to round up, but if they are planning physical activity you would do well rounding it down.

The 1800 Rule For Determining Your Correction Factor

When your blood sugar goes unexpectedly high, a correction bolus can be used to bring it down. To use the right correction bolus, you first determine your correction factor. The 1500 Rule for Regular was originally developed by Paul Davidson, M.D. in Atlanta, Georgia. Because the blood sugar tends to drop faster and farther on Humalog and Novolog insulins, we modified the 1500 Rule to an 1800 Rule for these insulins. The 1800 Rule shows how far your blood sugar is likely to drop per unit of Humalog and Novolog insulin. The 1500 Rule shows how far it will drop per unit of Regular.

Numbers between 1600 and 2200 can be used to determine the correction factor. The number 1800 should work when the TDD is set correctly and the basal insulin makes up 50% of the TDD in someone with Type 1 diabetes. A number smaller than 1800 will work better when basal insulin doses make up less than 50% of the TDD, while a number higher than 1800 works better for those whose basal doses make up more than 50% of their TDD. Also, recheck your TDD and basal percentage to make sure they are correctly set.

Setting up your correction boluses can be done only after your basal doses have been tested for accuracy. If your basal doses are set too high, using a correction bolus may lead to lows, while basal doses that are too low will make it appear that correction boluses are not the right amount to bring high readings down as expected.

The 1800 Rule:

Total Daily Insulin Requirement

= 500 ÷ TDI = 1unit insulin/ 12 g CHO

This example above assumes that you have a constant response to insulin throughout the day. In reality, individual insulin sensitivity varies. Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times. In such a case, the background insulin dose would still be approximately 20 units however, the breakfast insulin-to-carbohydrate ratio might be breakfast 1:8 grams, lunch 1:15 grams and dinner 1:12 grams.

The insulin to carbohydrate ratio may vary during the day.

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Carb Factor The 26 Rule

The 2.6 Rule is a great way to estimate how many grams of carbohydrate will be covered by one unit of Humalog, Novolog, or Apidra insulin. This is your insulin to carb ratio or your carb factor . Once you know this, you can count the grams of carb in the food you want to eat and divide by your carb factor to find how many units of bolus insulin are needed to cover the carbs. This allows flexibility in your food choices because any number of carbs can be covered with a matching dose of insulin.

Carbohydrate Count Is Used To The Following:

• Calculate how many units of insulin are needed for breakfast .
• Calculate how many units of insulin are needed for other meals .
• Calculate how much blood sugar drops by 1 unit of insulin, in order to correct its blood sugar during the day

The mathematics itself is simple and the vast majority of people quickly get good at carbohydrate counting. Remember that carbohydrate count is used to dose direct-acting insulin. The aim is thus to estimate how many units of insulin you need to take care of carbohydrates in food and drink.

You use three simple mathematical rules to do carbohydrate counting. These rules are called the 500 rule, 300 rule and 100 rule.

• The 300 rule is used to dose insulin for breakfast.
• 500 rule is used to dose insulin for other meals.
• 100 rule is used to estimate the effect of 1 unit of insulin, which can be used to correct blood sugar .

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How Much Insulin Should I Take: Correction

If your blood sugar is too high during a period of fasting , you can calculate how much of the blood sugar needs to be lowered.

To figure this out, youll need to know your correction factor, also known as the insulin sensitivity factor.

The correction factor is the amount of blood sugar that will be lowered by 1 unit of rapid-acting insulin.

This should also be figured out together with your healthcare team, using trial-and-error. Meanwhile, a helpful standard formula is the 100 rule or the 1800 rule.

Blood sugar is measured in either mmol/L or mg/dL. The 100 rule is for people who use mmol/L, while the 1800 rule is for those who use mg/dL.

These rules are formulas that involve dividing 100 or 1800 by your total daily dose. Thus: 100÷ total daily dose = the number of mmol/L of blood sugar dropped by 1 unit of rapid-acting insulin.

Alternatively: 1800 ÷ total daily dose = the number of mg/dL of blood sugar dropped by 1 unit of rapid-acting insulin.

Lets say again that your total daily dose is 50, giving you the following calculation: 100 ÷ 50 = 2. This means that 1 unit of insulin lowers 2 mmol/L of blood sugar.

Alternatively, the example could be the following calculation: 1800 ÷ 50 = 36. Accordingly, 1 unit of insulin lowers 36 mg/dL of blood sugar.

Total Daily Insulin Requirement:

= 500 ÷ TDI = 1unit insulin/ 12 g CHO

This example above assumes that you have a constant response to insulin throughout the day. In reality, individual insulin sensitivity varies. Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times. In such a case, the background insulin dose would still be approximately 20 units however, the breakfast insulin-to-carbohydrate ratio might be breakfast 1:8 grams, lunch 1:15 grams and dinner 1:12 grams.

The insulin to carbohydrate ratio may vary during the day.

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How To Figure Out Your Insulin

Calculating the best insulin-to-carb ratio is a process of trial and error:

Try this process out for a few days before adjusting your ratio. When you do adjust your ratio, do so in small, safe increments. When an insulin-to-carb ratio works consistently well, keep it! But remember that factors like illness, skipping a meal, extra exercise, stress and other changes in routine may cause your insulin-to-carb ratio to change.

Best Types Of Carbohydrates To Raise Your Blood Sugar

When youre trying to raise your blood sugar quickly, its best to stick to foods that are made up of mostly simple sugars. Foods with a lot of fiber, protein, or fat take longer to break down.

Here are some examples of simple carbohydrates you can use to raise your blood sugar, with approximate portion sizes to get 15 g of sugar:

• 4 glucose tablets
• 1/2 can of regular soda
• 3 pieces of hard candy
• 1/2 cup of fruit juice
• 1 tablespoon of sugar, syrup, or honey
• 1 dose of glucose tablets

Severe hypoglycemia below 54 mg/dL is too low to treat with the rule of 15. Depending on your symptoms, you may not be able to treat yourself or measure your own blood sugar levels.

According to the Centers for Disease Control and Prevention , injectable glucagon is the best way to treat severe low blood sugar. Glucagon is a hormone produced by your pancreas that stimulates the release of glucose from your liver into your bloodstream.

Glucagon kits are available by prescription. You can speak with your doctor about whether you need a kit.

Its important to treat low blood sugar as soon as you notice symptoms. This can help prevent your blood sugar from dropping to a severely low level.

Symptoms of mild low blood sugar include:

• shakiness or jitteriness

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Important To Consider With Carbohydrate Counting

The 500 rule, the 300 rule and the 100 rule are rough rules of thumb for how much direct acting insulin you need for a certain amount of carbohydrates. These rules are used both in Sweden and abroad and they are very good for learning how to dose insulin. In practice, however, you need to weigh more things in addition to the amount of carbohydrates, and you sometimes need to adjust the figures 500, 300 and 100 to better suit you. For example, the figure 450 may be suitable than 500 and this is something you learn over time .

Remember that the dose of insulin is affected by many factors, some of which are:

• How much to move before and after the meal.
• Blood sugar before the meal.
• What kind of carbohydrates you eat. If you eat fast carbohydrates, your blood sugar can rise fast even if you dose correctly. If you eat slow carbohydrates, you can actually get a blood sugar drop because slow carbohydrates take longer to take up.
• Insulin uptake may vary.

Additional Tips On The Insulin

• It is important that people remember to bolus before the meal. In most cases 10-15 minutes before you start eating is ideal.
• Many people have different ICRs for different meals. For example: they may have an ICR of 1:10 for breakfast, 1:8 for lunch and 1:12 for dinner.
• For the ICR to work accurately it is important that carbohydrates are counted correctly.
• The protein and fat content of meals can also affect BGLs and may need to be considered.
• A bolus is often required for larger carb snacks.
• Taking insulin before eating and then not eating all of the planned carbohydrate may cause a hypo when the rapid-acting insulin peaks.
• Taking bolus insulin after eating will result in a high blood sugar a few hours later.

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What Is The Downside Of The 500 Rule

The 500 rule is simple to use, but it comes at the expense of accuracy. After all, not all people eat exactly 500 grams of carb every day. Depending on body weight, age, sex, dietary preferences and many other factors, carb intake can vary widely.

With the 500 rule, overweight people tend to lowball their mealtime insulin needs, while leaner people will use too much. Therefore, more and more people are using a calculation that takes bodyweight into account. This approach also requires some trial & error and fine-tuning.

To learn more about the 500 rule and alternative ways of estimating mealtime insulin needs, talk to your primary doctor or an endocrinologist .

Carbohydrate Count With 500 Rule

The sensitivity of the body to insulin increases during the day, which makes it necessary to use less insulin compared to the need for breakfast. Therefore, the 500 rule is used for other meals. The 500 rule means dividing 500 by your total daily insulin. The figure you get corresponds to the number of grams of carbohydrates that 1 unit of insulin is enough.

Example:

Johanna needs a total of 40 units of insulin for one day. This includes both fast-acting and long-acting insulin.500/40=12.5.That is, 1 unit of insulin takes care of 12.5 grams of carbohydrates. Johanna decides to eat a meal with a total of 25 grams of carbohydrates and then he calculates that he needs 2 units of insulin.

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How Often Do I Check My Blood Sugar

You should check your blood sugar after taking extra insulin to ensure that your blood sugar drops appropriately.

The effectiveness of regular insulin peaks after approximately 3 hours. With rapid-acting insulin, its after about 90 minutes.

Speak with your doctor to learn when the best time is for you to check your blood sugar depending on the type of insulin youre using and other factors.

Calculations Of Carb To Insulin Ratios For Type 1 Diabetes

A carbohydrate to insulin ratio is the amount of insulin used to lower the blood sugar from a particular amount of grams of carbohydrates eaten. For example, some people have a 15:1 carbohydrate-to-insulin ratio or they take 1 unit of insulin for every 15 grams of carbohydrates they eat. But other Type 1s need 1 unit of insulin for every 10 or even 8 grams of carbohydrates. Every person responds a little differently to insulin.

The 450/500 rule goes as follows:

If a person is taking rapid-acting insulin such as Humalog, Novolog or Apidra they would follow the 500 rule which states:

Divide 500 by the total daily dose of insulin. The result is the grams of carbohydrates that are approximately covered by 1 unit of insulin. For example, add up all the insulin you take for the day and divide by 500. If your total daily dose was 45 units, you would divide 500 by 45 and your ratio would be 11:1.

If a person is taking short-acting insulin such as Humulin R or Novolin R they would follow the 450 rule which states:

Divide 450 by the total daily dose of insulin. The result is the grams of carbohydrates that are approximately covered by 1 unit of insulin. For example, add up all the insulin you take for the day and divide by 450. If your total daily dose was 45 units, you would divide 450 by 45 and your ratio would be 10:1.

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How Is The Insulin

Many diabetes healthcare professionals use what is called the 500-rule to calculate ICR. They take the number 500 and divide it by your current total daily dosage of insulin.

So first we need to establish what the Total Daily Dosage is. Its derived by adding all basal or long-acting and all bolus or rapid-acting insulin that is taken in a 24-hour period.

If your insulin intake varies from one day to the next it is often recommended to do this for a few days and take the average over, for example, three to four days.

To give an example, if you take Levemir, with 12 units in the morning and 14 units at night and you take 8 units of Novorapid at breakfast, lunch and dinner, your TDD will be: 12+14+8+8+8=50 and 500 divided by 50 is 10.

This means that your ICR is 1:10: you need 1 unit of rapid-acting insulin for every 10g of carbs. This could also be written as 1.5 units per 15g serve of carbs.

To check if your ICR is correct you should check your blood glucose level two to three hours after eating. If the BGL is 1-2 mmol/l higher than it was before the meal your ICR was spot on .

If your after-meal BGL is more than 3 mmol higher than what it was before the meal, you need to consider making your carb ratio stronger or review your carb counting skills.

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Diabetes can be managed through oral medications. In addition to insulin, metformin, which is a sugar-reducing agent, is also a common treatment for diabetes. It is considered a first-line therapy for diabetes treatment and is often added to insulin. It is important to know the risks of taking diabetes medications. Some drugs can be addictive, so you must consult your doctor before taking any medication. Your physician can prescribe you an appropriate treatment plan based on your medical history.

Your doctor will prescribe medication and check your blood glucose levels on a regular basis. Your A1c level will be checked every six months and your cholesterol levels will be tested regularly. Your doctor will also look for any signs of retinopathy, which is damage to the nerves in the eye caused by diabetes. You will also be examined for any foot problems. It is important to see a foot specialist regularly. Your feet should be thoroughly inspected for damage to the nerves.

While the first two types of insulin are the most common treatments, diabetes can be treated in a variety of ways. Your doctor may prescribe medications to control high blood pressure, which can protect the kidneys. Other types of medication include aspirin and other types of anti-platelet drugs. If your doctor is concerned about your blood sugar level, you may need to try a different medication. Some medications can cause side effects. Your treatment will depend on what type of insulin you need.

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How Do You Determine Insulin Dosage

Once you know how sensitive you are to insulin, you can figure out how much insulin you need to give yourself to lower your blood sugar by a certain amount.

For example, if your blood sugar is 200 mg/dL and youd like to use your rapid-acting insulin to lower it to 125 mg/dL, youd need your blood sugar to drop by 75 mg/dL.

From the insulin sensitivity factor calculation, you know that your rapid-acting insulin sensitivity factor is 1:60. In other words, one unit of rapid-acting insulin lowers your blood sugar by about 60 mg/dL.