1. 50% Basal Total Daily Dose Split to mimic Euglycemic control 50% Bolus Establishing Starting Basal and Bolus Dosing Based on Pre-Meal Readings and Carb Counting Determining the starting Carb Ratio and Correction Factor

2. 500 Rule: 500 divided by TDD Example: 500 / 50 = 10 Insulin to carb ratio = 1u for 10g Insulin Sensitivity or Correction Factor 1800 rule Humalog/Novolog/Apidra 1800 divide by TDD= mg/dl drop in BG Example: 1800/50 = 36 mg/dl Insulin sensitivity ratio = 1u for 36mg/dl 1500 rule Regular Insulin 1500 divide by TDD=mg/dl drop in BG Example: 1500/50 = 30 mg/dl Insulin sensitivity ratio = 1u for 30mg/dl

3. Ms. Johnson has A1c of 7.6 and is on  Glargine (Lantus) 60 units at bedtime  Lispro(Humulog) sliding scale with average daily dose of 30 units  Usually takes 3 correction shots based on pre-meal readings: If BG is  120-150 - 3 units  151-180 - 5units  181-210 - 7units  211-240 - 9units  241-270 -11units

4. Ms. Johnson’s starting Glargine dose is 45 units Her total daily dose is 90 units and using the 50/50 ratio her basal dose would be 45 units. Her target should be established at no more than 50 mg/dl below average BG A1c 7.6 = average bg of 170mg/dl Target could be 120 mg/dl

5. Ms. Johnson’s sensitivity to 1 unit of Rapid Acting insulin will be: 20 mg/dl Using the 1800 rule for rapid insulin as described: 1800/90= 20 mg/dl Ms. Johnson’s carb ratio to 1unit of Rapid Acting Insulin will be 5 carbs Using the 500 rule for rapid insulin as described: 500/90= 5 carbs

6. Ms. Johnson’s pre-lunch reading is 220 mg/dl and she is going to eat 70 carbs her dose of Apidra would be: 1. 5 units 2. 14 units 3. 16 units 4. 19 units 5. 23 units Carb ratio is 5carbs/unit so 70/5 =14 units for food Sensitivity is 20mg/dl/unit to a target of 120 so 220mg/dl -120mg/dl =100 mg/ dl so 100/20= 5 units for correction 14 units for food +5 units for correction 19 units total needed