Replies to This Discussion

Permalink Reply by HPNpilot on February 12, 2013 at 10:37am

On average, in published studies, Type 1's with little/no native production have an average total daily dose of about 0.7-0.8 units/kg of body weight. Basal would be between 40 and 60% of the TDD according to the books "Using Insulin" or "Pumping Insulin" books.

Naturally, as with everything in diabetes, there is a great deal of individual variation. The numbers above are averages.

To give an example of the calculation above, a 100 lb T1 is 45 kg or so. 45 kg * 0.8 units/kg is about 36 units TDD. So basal might be in the range of 40-60 % of this....
or 14.4 to 21.6 units per day.

As for myself, I weigh 170 lbs or 77 kg, which would predict about 61 units a day of TDD. I use about 67 units a day, of which I use a total of 36-39 units a day of basal at various rates.

And yes, that amount has increased from 10 units a day basal 2 years ago at diagnosis as the autoimmune process of destruction of beta cells progresses and native insulin production falls off.

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Permalink Reply by Zoe on February 12, 2013 at 10:47am

Those figures seem quite high to me, HPN. I don't think most type 1's take that much unless they've developed insulin resistance. I never found those "per body weight" formulas as too accurate. I think degree of insulin resistance is a lot more a factor than a relatively small difference in body weight. Other factors include diet and exercise.

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Permalink Reply by HPNpilot on February 12, 2013 at 12:06pm

As I said, there is a great deal of variance between individuals.

The averages I got come from the data sheets of, for instance, Novolog, which showed in their trials that their T1 users were using , on average, 0.7 u/kg +/- 0.2 u/kg.

TDD

Weight will have some influence - a 170lb person will likely uses more than a 100lb person. Since insulin is the "key" that lets glucose into cells, someone with more mass with have more cells and need more insulin.

I do agree with you that the degree of insulin resistance makes a big difference.

UCSF's diabetes center, for instance, uses a formula of 0.55 u/kg as a starting dose estimate to be conservative.

Of course all these need to be tuned to tthe individual, that is why the doctors and CDEs start off small and ramp up.

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Permalink Reply by Zoe on February 13, 2013 at 9:05am

Exactly, those figures are a "starting base", just like the 1:15 I:C ratio some doctors/dieticians use, then we have to figure it out by trial and error. Those per kg rates take no account of insulin resistance or carbs eaten. And they still sound high to me. For my weight the .55 figure which is supposedly conservative would give me a TDD of 34.65. When my doctor who thought I was Type 2 started me out he started me at 25 basal and about another 6 bolus. I was crashing like crazy.

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Permalink Reply by Jen on February 12, 2013 at 7:26pm

I have read these same statistics in another book (I think Type 1 Diabetes in Children, Adults, and Young Adults). I'm pretty sure it said newly-diabetes people are considered to be honeymooning if they take less than 0.5 units per kg of body weight, and considered to be insulin resistant if they take more than 1.0 units per kg of body weight. So I think these are probably pretty accurate.

I do think one important thing being left out here is carbohydrate consumption, since a lot of people on this site eat a lower than average number of carbohydrates, even if they aren't on an actual low-carbohydrate diet.

For myself, I take about 27 units of basal insulin but have a TDD of around 42 units. (I am overweight, but not insulin resistant, and when I weighed much less my basal was about 18-20 units.) Using the insulin to kg formula, I'm supposedly only taking about 0.4 units per kg of body weight. But I only eat about 100 grams of carbohydrates most days. If I ate 300 grams of carbohydrates, my dose would be 0.6 units per kg of body weight. And, since this is probably closer to what many Type 1s eat, I think it's probably what the calculations are based on. (If I ate 300 grams of carbohydrates I'd also have a 47/53 basal/bolus split, but in reality my split is closer to 65/35 since I eat less carbohydrates than most people.)

I was diagnosed at age 9 and have been Type 1 for over 21 years, so I'd be very surprised if I'm producing any significant amount of insulin (though I've never had a c-peptide test so really have no idea).

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Permalink Reply by Natalie ._c- on February 13, 2013 at 2:58pm

The figures seem high to me, too. I weigh about 70 kg. and if I used 0.7u per kg, that would be a TDD of 49u. But I'm normally somewhere in the upper 20's, lower 30's -- the only time I even get above 40 is if I binge. (Being honest here!)

So I do think it depends a lot on each person's insulin sensitivity; some people are naturally more sensitive (or resistant -- same idea, different word!) than others, and at best such numbers are an average. But even as an average, it seems off to me -- I'm by no means the most insulin sensitive person in the world!

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Permalink Reply by Holger Schmeken on February 12, 2013 at 11:19am

I am T1 since 1987 and take Lantus: 7 units at 08:00 and 5 units at 22:00. With 12 units you have the same sensitivity to insulin. I would assume that your LADA phased out in the past two years.

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Permalink Reply by Clare on February 12, 2013 at 11:24am

Hi Jenn,
I am T1 for 37 years and take 25 units of basal per day in 2 shots. One when I get up in the morning and one at 8:30 pm.
I can only speak for myself ,but my basal requirement has gone down over the last year. For many years I was taking 30 units a day but lowering my carb intake, exercising more and dropping some weight have all combined to allow me to use less.
I don't think basal doses are based on weight. Although the initial dose may be determined that way. After the initial dose, it is entirely dependent on how each individual patients' blood sugar reacts. So this is another case where YDMV(your diabetes may vary). Insulin sensitivity, insulin resistance, the time of the month, the phase of the moon and any number of other things can change how your blood sugars react to basal insulin. (Actually the phase of the moon is unlikely to have an effect, but I threw it in to show how variable D can be.)
So to simply answer, yes basal rates change over time. And no it is not my experience that they continue to rise. In some instances they actually decline.

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Permalink Reply by Capin101 on February 12, 2013 at 11:29am

My basal is approximately 41 to 43 units winter and 36 to 38 units summer. My basals have been similar to this for quite a while. I remember taking 45 units of NPH as basals in the 90's and 40 something units of lantus in the 2000s. I have added a few pounds in the last 5 years and my basal needs have increased accordingly. I do not think I have any IR?

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Permalink Reply by TC on February 12, 2013 at 12:27pm

My son is nearing a 100 pounds and he takes 18 - 20 units of insulin daily for his basal depending on activity. His basal needs have correlated well with his growth. Also, he is taking around 20 units for his meal boluses daily.

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Permalink Reply by Kathy on February 12, 2013 at 1:09pm

About 25u per day. Type 1 for 39 years.

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Permalink Reply by Tami on February 12, 2013 at 2:24pm

11.68units is my total daily T1 for 20yrs and pumping for 3yrs

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