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Questions...

Discussion in 'Parents of Children with Type 1' started by ccarrol4, Mar 10, 2011.

  1. ccarrol4

    ccarrol4 Approved members

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    Can anyone tell me how an insulin like humalin 70/30 works?

    Also, does anyone know the formula for figuring out insulin needs based on weight? I saw that post here once...
     
  2. wilf

    wilf Approved members

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    It is a mix of 70% NPH and 30% Regular insulin. It is more commonly used for Type 2s who are still producing some of their own insulin. It is commonly given in 2 injections a day, before breakfast and before supper.

    Regular insulin starts working between 30 and 60 minutes after injection, and peaks at between 2 and 3 hours after injection. NPH starts working after about 1.5 to 2 hours after injection, and at smaller doses peaks between 4 and 7 hours after injection. NPH also has a long "tail", which means it keeps working for many hours after injection (to between 10 and 14 hours).

    Here is an example of the way it might work:

    Breakfast Injection of 10 units 70/30 mix:
    - there are 30% of 10 units or 3 units of Regular to cover breakfast;
    - there are 7 units of NPH which have a dual function of covering lunch (which would need to be about 4 hours after the morning injection) and providing basal insulin during the day.

    Supper Injection of of 10 units 70/30 mix:
    - 3 units of Regular would be covering supper;
    - 7 units of NPH would have the dual function of covering a bedtime snack (which would need to be about 4 hours after the supper injection) and providing basal insulin overnight.

    If a non-honeymooning Type 1 were to try to use this insulin they would need to prebolus for their meals by about 90 minutes (ie. to not eat until 90 minutes after injection), to give the Regular insulin time to get working.

    It would be exceedingly challenging to use 70/30 mix in a Type 1 child unless they were still honeymooning. The lifestyle would be regimented - set amounts of insulin, meals of set size, everything on a rigid schedule. There would be frequent highs (big spikes after meals during the day) and an unacceptable risk of lows overnight.

    There are a few old school endos who still use it, but I would not recommend it for anyone.

    *****

    There is no formula for insulin needs. A child needs as much insulin as is needed to cover the carbs in their meals and their basal needs.

    Typically you'll see insulin needs of about 0.5 to 1 unit of insulin per kg body weight per day in children who are not honeymooning and are not going through puberty, but there is huge variability from child to child and even for each child.
     
  3. dejahthoris

    dejahthoris Approved members

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    There is an insulin total daily dose (TDD) table (by weight) on page 120 of the book "Using Insulin" by Walsh.
    It is sorted by different factors as well: such as levels of activity(fit, sedentary, adolescent) pregnancy, time from diagnoses, stress, infection, dka, etc. I can look at it for you if you need something specific.
     
  4. TheFormerLantusFiend

    TheFormerLantusFiend Approved members

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    At the age where insulin needs peak, the range for insulin use per day that is the norm for type 1s is 0.7 u/kg/day- 1.2 u/kg/day. For children and adults, the normal range is more 0.5-1.0 u/kg/day. There are various factors other than weight involved, and this is very much an average. Especially a few of years ago when I was much more in puberty, but even now, my insulin intake on any particular day could be a third or twice as much as my average.

    If you want that in more of a chart format, given the weights I would see as reasonably normal for a young woman:

    If the person is around 99 lb = 45 kg, expect insulin needs around 22.5-45 units per day for an adult, 31.5- 54 units for an adolescent (may include early 20s).
    If the person is around 110 lb = 50 kg, expect insulin needs around 25-50 units per day for an adult, 35-60 units for an adolescent.
    If the person is around 121 lb = 55 kg, expect insulin needs around 27.5-55 units per day for an adult, 38.5-66 units per day for an adolescent.
    If the person is around 132 lb = 60 kg, expect insulin needs around 30-60 units per day for an adult, 42-72 units per day for an adolescent.
    If the person is around 143 lb = 65 kg, expect insulin needs around 32.5-60 units per day for an adult, 45.5-78 units for an adolescent.
    If the person is around 154 lb = 70 kg, expect insulin needs around 35-70 units for an adult, 49-84 units for an adolescent.
    If the person is around 165 lb = 75 kg, expect insulin needs around 37.5-75 units for an adult, 52.5-90 units for an adolescent.
    If the person is around 176 lb = 80 kg, expect insulin needs around 40-80 units for an adult, 56-96 units for an adolescent.
    If the person is around 187 lb= 85 kg, expect insulin needs around 42.5-85 units for an adult, 59.5-102 units for an adolescent.
    If the person is around 198 lb = 90 kg, expect insulin needs around 45-90 units for an adult, 63-108 units for an adolescent.
     

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