Insulin types and amount
insulin dose pages from DAFNE
Insulin & DAFNE
DAFNE uses human genetically engineered insulin.
There are other insulins, such as pork and beef, but here we concentrate
on the insulins used in the DAFNE program.
How much insulin do you need?
In type 1 diabetes, most people need a total of 0.5 - 0.8 units of
insulin per kilogram of body weight each day. Roughly half this insulin is
needed for food intake, and half is the basal rate.
In DAFNE half is therefore taken as long-acting
insulin and this is divided
into two injections of Levemir (detemir) insulin. One injection when you
get up in the morning, and the other in the evening at bedtime. For most
people, this is about 24 units in 24 hours.
The amount of background insulin does not depend on what you eat, and the
dose should be low enough to allow you to miss meals without the risk of
low glucose (a hypo), whilst still keeping the glucose levels within the
The remainder of the total daily dose is taken at meal times, as a quick
acting insulin. Sometimes these are given as insulin mixtures, but not in
the DAFNE program.
The quick-acting (QA) part of the total daily dose is taken at meal times,
matched to the carbohydrate. Think of this as food-related insulin that is
taken immediately before food. Generally, you need 1-3 units of insulin per
carbohydrate portion (CP) at breakfast, and between 1-2 units QA insulin
per CP at other meals. These ratio of QA : CP may vary depending on the time
of day. Detail
Everyone has different insulin needs...you learn how to calculate your own
requirements on the DAFNE course.
The quick acting
insulins that are now popular in the UK are
- Humalog (Lispro)
- Novorapid (Aspart)
- Apidra (Glulisine)
They start to work 15 minutes after the injections, and continue to lower
glucose levels for 2-5 hours.
Long-acting (background) insulin
NICE 15 prefers twice daily Levemir (detemir). Levemir (detemir) insulin has a peak
action at 9-12
hours, but still has a little
action at 24 hours.
Many type 1 patients use Lantus (Glargine) insulin...Lantus is more
- see insulin injection technique, basic
insulin rules, link;
- in the UK most insulin is U100....100 units
- do not inject insulin past its expiry date
- it must be stored at the correct temperature in domestic fridges
- it must not be frozen as that destroys it
- the best place to inject insulin is into the fatty layer beneath the
- inject at a 90 degree angle using a short 6 or 8 mm needle
- Abdomen, thighs, or buttocks are ideal injection areas
- insulin is absorbed more quickly form the abdomen
- vary injections sites to prevent hard lumps forming under the skin..these
lumps affect insulin absorption (it may take longer or less time to work...this
- there is no need to clean the skin first
- a carbohydrate portion is an egg-size potato, 10 gm carbohydrate
- this increases glucose level 2 mmol/g
- so 4 egg-size potatoes = 40 gm carbohydrate
- what is you insulin need per unit of carbohydrate? your nurse will advise, but an average will be 1.5 units of insulin for each carbohydrate portion.
- This ratio (eg 1.5) will de different at breakfast time, lunch time etc, but is usually similar for each lunch. (stress, exercise, illness, also affect this level; so does obesity)
- so if you eat 4 potatoes you will need 6 units of insulin.
- But then you need to take into account the blood glucose level when tested just before the meal....10gm of glucose may increase glucose level 2mmol/g. So if your pre-meal glucose level is 10.4, and you are going to eat 4 potatoes, you will need
- 6 units of insulin for the potatoes
- 3 units extra to drop the insulin 4mmol/g to 6.4 (from 10.4)