Insulin Unit Distribution & Diet Chart for Diabetic Patients

PART 1: INSULIN UNIT DISTRIBUTION

Step 1 - Calculate Total Daily Insulin (TDI)

• TDI = 0.5 × 70 = 35 units/day

Step 2 - Distribute Insulin (Basal : Bolus Split)

Standard Regimen: 40% Basal + 60% Bolus

• Basal = 40% × 35 = 14 units at bedtime
• Bolus = 60% × 35 = 21 units ÷ 3 meals = 7 units per meal

Alternative Regimen: 50% Basal + 50% Bolus

• Basal = 50% × TDI at bedtime
• Bolus = 50% ÷ 3 meals

Step 3 - Age-Based Adjustments

Step 4 - BMI / Weight Adjustment

• Males: 50 kg + 2.3 kg per inch over 5 feet
• Females: 45.5 kg + 2.3 kg per inch over 5 feet

Step 5 - Insulin-to-Carbohydrate Ratio (ICR) and Correction Factor

• Use the "500 Rule": ICR = 500 ÷ TDD (total daily dose)
• Children with TDD <1 unit/kg: use the "300 Rule"

• CF = 100 ÷ TDD
• Example: TDD = 50 units → CF = 2 (each unit lowers BG by ~2 mmol/L)

PART 2: DIET CHART FOR DIABETIC PATIENTS

Step 1 - Calculate Calorie Needs

• Reduce intake by 500-750 kcal/day from maintenance
• Women: target 1,200-1,500 kcal/day
• Men: target 1,500-1,800 kcal/day

Step 2 - Macronutrient Distribution

• Carbohydrates: Minimum 130g/day; prefer 40-45% of total calories; choose low glycemic index foods
• Protein: 1.0-1.5g/kg body weight/day (10-20% of total energy); adjust downward if diabetic kidney disease
• Fat: ~30% of total calories; limit saturated fat <10%; avoid trans fats
• Fiber: ~14g per 1,000 kcal; aim for 20-35g/day minimum; up to 50g/day helps postprandial glucose control

Step 3 - Sample Diet Chart (1,800 kcal - Moderate Activity Adult)

Step 4 - Foods to Choose vs. Avoid

Step 5 - Special Considerations by Age

Sodium & Micronutrients

• Sodium: <2,300 mg/day; reduce to <1,500 mg if age >50 or hypertension or CKD (ADA/Joslin guidelines)
• Potassium: Minimum 4,700 mg/day (from fruits/vegetables)
• Calcium: 1,000-1,200 mg/day (especially elderly)

Summary Formula

1. TDI (units) = 0.3-0.5 × body weight (kg)
2. Basal = 40-50% of TDI (once at bedtime)
3. Bolus = 50-60% of TDI (divided equally at 3 meals)
4. Calories = IBW × kcal factor (25-40 kcal/kg based on activity)
5. Carbs: 40-45% | Protein: 20-30% | Fat: ~30%
6. Adjust everything for age, BMI, activity, kidney function, and blood glucose response

Important: These are starting calculations. All insulin doses and diet plans must be individualized and monitored by a physician or registered dietitian. Blood glucose targets (fasting 4-7 mmol/L, post-meal 5-10 mmol/L) guide ongoing adjustments. Per ADA Standards of Care 2024, all patients with diabetes should be referred to a Registered Dietitian Nutritionist (RDN) for personalized Medical Nutrition Therapy (MNT).

Books to Study Insulin Dosing & Diabetic Diet

Books Available in This Library (You Can Ask Me Questions From These)

1. Internal Medicine (Diabetes Management - Core)

2. Pharmacology (Insulin Types, Mechanisms, Dosing)

3. Physiology (How Insulin Works, Glucose Regulation)

4. Biochemistry (Glucose Metabolism, Diabetes Pathophysiology)

5. Family Medicine (Practical Diet Counseling)

6. Pediatrics (Insulin in Children)

Recommended Study Order

1. Physiology (Guyton / Ganong / Costanzo)
        ↓ Understand how insulin works
2. Biochemistry (Harper's / Lippincott Biochemistry)
        ↓ Understand glucose metabolism
3. Pharmacology (Katzung / Lippincott Pharmacology)
        ↓ Learn insulin types, dosing formulas
4. Internal Medicine (Harrison's / Goldman-Cecil)
        ↓ Full clinical management + diet guidelines
5. Washington Manual
        ↓ Quick practical reference for clinical use

External Books / Resources (Not in Library - Highly Recommended)

For nursing / dietetics students specifically: The ADA's Guide to Nutrition Therapy for Diabetes and the Joslin Clinical Nutrition Guidelines are the most directly applicable resources for diet chart preparation and calorie distribution planning.

How to Calculate Carbohydrates According to Insulin Units

STEP 1 - Find the Total Daily Dose (TDD) of Insulin

TDD = Basal insulin + All bolus insulin doses

• Glargine (basal) at night = 26 units
• NovoRapid (bolus) at breakfast = 8 units
• NovoRapid (bolus) at lunch = 8 units
• NovoRapid (bolus) at dinner = 8 units
• TDD = 26 + 8 + 8 + 8 = 50 units

STEP 2 - Calculate the ICR Using the "Rule of 500"

STEP 3 - Calculate Insulin Needed for a Meal

• Insulin needed = 60 ÷ 10 = 6 units

STEP 4 - Add Correction Dose (if blood sugar is high)

• ISF = 1800 ÷ 50 = 36 mg/dL (1 unit lowers blood sugar by 36 mg/dL)

• Correction = (220 - 110) ÷ 36 = 110 ÷ 36 = 3 units

STEP 5 - Total Mealtime Insulin

Special Rule for Children: "Rule of 300"

Quick Reference Table - Typical ICR by Body Type

Worked Example (Full Calculation)

• Takes: 20 units Glargine (night) + 8 units Lispro (each meal × 3)
• TDD = 20 + 8 + 8 + 8 = 44 units

• 1 unit covers 11g of carbohydrate

• 55 ÷ 11 = 5 units

• If pre-lunch BG = 180 mg/dL and target = 110:
• Correction = (180 - 110) ÷ 41 = 1.7 → round to 2 units

• 5 (meal) + 2 (correction) = 7 units before lunch

How to Verify the ICR is Correct

• If BG is within 3 mmol/L (or ~50 mg/dL) of pre-meal BG → ICR is correct
• If BG rises more than that → ICR is too weak (lower the number, e.g. 1:11 → 1:9)
• If BG drops too low → ICR is too strong (raise the number, e.g. 1:11 → 1:13)

Summary of All Formulas

Important: ICR varies by time of day (many patients need a stronger ratio at breakfast due to the dawn phenomenon). Always round doses to the nearest 0.5 or 1 unit and confirm with the treating physician or diabetes educator. The IHS Carb Counting guide and Diabetes Educators Calgary are excellent practical references for these calculations.