Insulin:CHO ratio

• Method #1: Food diary, insulin dose, and SMBG Information

Insulin:Carbohydrate ratio = Grams of carbohydrate at a given meal ÷ number of units
of insulin taken at that meal

Example: Client needs 4 units of insulin to cover 45 grams of carbohydrates

Insulin:Carbohydrate ratio = 45 ÷ 4 = 11.25

Ratio = 1:11

• Method#2: The rule of 450 (For regular insulin) or 500 (for rapid acting such as
Humalog)

Insulin:Carbohydrate ratio = 450 or 500 ÷ total daily insulin dose (TDD)

TDD = 36 units

Glucose levels are within target range

Insulin:Carbohydrate ratio = 500 ÷ 36 = 13.8 (round up to 14)

Ratio = 1:14

• Method#3: Using the insulin sensitivity factor (ISF)

ISF = 1500 (for regular) or 1800 (for rapid) ÷ TDD

Insulin:Carbohydrate ratio = ISF× 0.33

TDD = 25 units

ISF = 1800 ÷ 25 = 72 mg/dl

Insulin:Carbohydrate ratio = 72 × 0.33= 23.8 (round up to 24)

Ratio = 1:24
 • Correction Factors

Glucose = 264mg/dl

Target glucose level is 100 mg/dl

ISF = 53 mg/dl

Difference between target and actual glucose levels = 264 – 100 = 164 mg/dl

ISF= 164 mg/dl ÷ 53 mg/dl = 3.1 units

The correction dose of insulin is 3 units

Example: given the following

- Fasting glucose:300mg/dL.
- Target fasting blood glucose :100mg/dL
- TDD : 30units
- Regular insulin is used

Calculate the INS/CHO ratio

Method 2:

INS/CHO : 450/30= 15 so the ratio is 1:15

Method 3:

ISF= 1500/30= 50mg/dL.

INS/CHO: 50x0.33= 16.5units so the ratio is: 1:16.5

How much insulin you need to correct the glycemia

ISF= 50mg/dL.

The difference between the actual glycemia and the target is (300-100= 200mg/dl) 200mg/dl.

If 1 unit of regular insulin drops the glycemia by 50mg/dl so 4 units will drop the glycemia by
200mg/dl and will correct it.

If the patient is planning to eat at BF 45g of CHO and prior to the insulin injection his
glycemia was found to be 300mg/dl. How much insulin unit should he inject himself:

First as previously calculated, he needs extra 4 units to correct the glycemia and reach 100mg/dl.
According to method 2: INS/CHO ratio is 1:15 means he needs to inject himself with 3 units of
insulin to cover the 45 g of CHO

Total of insulin injected: 3 units (to cover 45h CHO) + 4 units to correct the glycemia= 7units of
insulin should be injected before the BF