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April 12, 2007

Insulin

Question from Buffalo, New York, USA:

I know that you were asked this question before, but you never really answered it. Where on the web can I find the guidelines for weight versus carbohydrate to insulin ratio? My son is seven and weighs 63 pounds. He is taking one unit of insulin for every 19 grams of carbohydrates. With his last A1c 8.5, I think he should be on one unit for 17 or 18 grams of carbohydrates. Where can I find information about this on the web?

Answer:

I’m sorry that this question hadn’t been answered to your satisfaction. I do not know of any specific web site that addresses your question, but I think the question is also unclear to me.

All individuals with type 1 diabetes will likely have slightly different insulin requirements depending upon their growth, their general health, other medications, activities, etc. The insulin-to-carbohydrate ratio is generally around one unit for every 10 to 15 grams for everyone, but it could be more (one unit for every 5 to 7 grams) or less (one unit for every 20 to 30 grams). I would not expect it to be based specifically for the individual’s weight.

If you and your child’s diabetes team believe that he requires one unit of insulin for every 19 grams of carbohydrates that he eats, then it is reasonable and easy to try it. A nice way that you can tell if your ratios are correct is to check the glucose reading about one and a half to two hours after a meal and insulin bolus to see if the glucose is within the target. I think that getting the follow-up glucose within 50 mg/dL [2.8 mmol/L] of the pre-meal glucose suggests that the insulin-to-carbohydrate ratio was close.

If this does not help with your question, I strongly advise that you speak with your own diabetes team and nutritionist.

DS