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insulin confussion...!!!

Discussion in 'Ask A Question' started by kelmes, Apr 17, 2012.

  1. kelmes

    kelmes · Newbie

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    My son has been diagnosed with type 1 and is currently in hospital still, his doctor says he'll be out on thursday and has run through his insulin and diet needs, however I'm finding it REALLY hard to make all the maths work! it dosn't help either as we live in Spain so am having to translate everything, I understand about his glucose levels and when they should be checked but how I turn that into a dose of insulin i'm having trouble with!! any ideas gratefully recieved...!
     
  2. SophiaW

    SophiaW Type 1 · Well-Known Member

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    Hi, I'm sorry about your son, it's very difficult in the beginning as there is so much to learn and absorb. Your son's diabetes specialist/doctor should be able to provide you with the doses of insulin that are needed. We might be able to offer some advice but first you will need to let us know what type of insulin your son has been prescribed. There are different types of insulins and regimes so knowing which one your son is on will help us. Have they asked you to calculate the carbohydrates in the food your son eats and adjust the insulin dose accordingly? Or is he on a set dose of insulin at certain times of the day?
     
  3. ebony321

    ebony321 · Well-Known Member

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    Hi,

    A good thing for you to do is to definitely keep a diary, keep a record of his blood glucose results, what food he's eating (the amount of carbohydrates if you are matching insulin to carbs) and how much insulin your giving. This is a great habit to get into right from the beginning no matter which insulin you are using.

    This will help you spot any mistakes or even better see what doses are working well, the more you practice the better at it you will get, it's hard in the beginning and there is alot to remember and worrying about it makes it worse, we've all been there! but that also means we can assure you it does get easier.

    There are many parents here that can give you great advice and support so feel free to post any questions or worries :)
     
  4. kelmes

    kelmes · Newbie

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    he's on Humalog and levemir at the mo, and have to count his carbs, I'm hoping the penny might drop today and the maths might come easier.....!!! :?
     
  5. SophiaW

    SophiaW Type 1 · Well-Known Member

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    Your doctors should have given you some ratios to work from when calculating the insulin (humalog) dose for the amount of carbohydrates to be eaten. It's called the insulin to carb ratio and is written something like 1:15 which means 1 unit of insulin for every 15g of carbs to be eaten. If you know how many carbs your son is going to eat for the meal, and you know his insulin to carb ratio then you simply divide the number of carbs by the larger number in the carb ratio. For example if he's going to eat a meal containing 45g of carbs, and his insulin to carb ratio is 1:15, then it would be 45 divided by 15, that calculates at 3 units of insulin needed. If you get a number that isn't a whole or half fraction then round it up or down to the nearest half unit. Is your son using an insulin pen that dials half units? Some pens only dial whole units so make sure you get a half unit pen as children need smaller doses and the half unit pen is much better for that. Your son's insulin to carb ratio might change depending on the time of day so you may have been given more than one ratio. When my daughter was on injections she had a different ratio for breakfast, lunch and supper.

    Your doctor might have also given you an insulin sensitivity factor (ISF) which means how many mmol/l your son's blood glucose will fall when given 1 unit of rapid acting insulin (humalog). If your son has a high blood glucose level, and provided the high reading was taken more than about 4 to 5 hours after his last injection, then you can give a correction dose of rapid acting insulin to bring his reading down. This is when you'd use the insulin sensitivity factor to calculate how much insulin to give to bring the reading down into target range. For example if his reading is 19mmol/l and it's been 5 hours since his last injection then you can give a correction dose. If his ISF is 5 that means for every 1 unit of insulin injected his reading will fall by 5mmol/l. For the reading of 19mmol/l you would want to give him about 2 units of insulin which will bring his reading to about 9mmol/l. This is only an example, you will need to know what your son's ISF is to be able to calculate it correctly, everyone is different so what works for one person will not be the same dose for another. You doctor needs to work the ISF out and provide you with the numbers.

    For working out the carbohydrates there is a book called Carbs & Cals which might be useful, there is a mobile phone app for it too which I use a lot. Reading the nutrition labels on food packaging might provide you with some information for working out the carbs and a set of kitchen scales will be very useful to weigh food. If you know what the carbohydrate content of the food is per 100g, and if you can weigh the portion that your son will eat, then it's fairly simple to work out how many carbohydrates it contains. For example if your son is going to eat a portion of peas: The peas are 8.9g per 100g (Find this on the packaging, in a carbs & cals book or even online), the portion size is 50g, you take 8.9 (amount of carbs per 100g) multiply it by 50 (weight of portion) and then divide by 100. In this example the carb content of the peas for that size portion is 4.45g. It seems a fuss in the beginning but it gets easier and once you know the carb values of foods that you eat often then it's quick to work it all out. I typed up, printed and then laminated a table of all the foods we commonly eat together with the carb content per 100g, this acts as an easy reference for me rather than going online trying to search the information or looking through a book. When I dish up the meal I weigh and then work out the carb content of each food type, add them all together and that tells me how many carbs are in the meal. From there you can use the insulin to carb ratio to work out how much insulin is needed, plus if the blood glucose reading is high you can also calculate if a correction dose is needed and add that to the insulin needed for the meal.

    I also strongly recommend buying a book called Type 1 Diabetes in Children, Adolescents and Young Adults (available on amazon), it explains so much about type 1 in a way that I could understand, without it, and the support I have had at this forum, I think I would have been very lost.

    Sorry it looks like I've written an essay. I hope I haven't explained the obvious that you already understand, but I'd rather explain too much than be vague and assume you already know when perhaps you don't :D
     
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