Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-54

• The scale is a list of correction factors. A correction factor is a term that comes from pump therapy. Insulin sensitivity factor (ISF) or correction factor (CF) is the estimated number of mmol/L the BG will lower over a four-hour period that 1 unit of insulin will produce (63).

Insulin sensitivity is used to determine the amount of the correction bolus needed. An insulin sensitivity factor may also be called a correction factor (CF).

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● Calculating how much 1 unit of insulin will drop BG is a process of trial and evaluation. Sensitivity to insulin is unique and can vary throughout the 24-hour period. Various formulae have evolved over the years: ● For most adults, 1 unit of rapid-acting insulin will lower blood glucose by 1.1-2.7 mmol/L (61). A common CF for adults with type 2 diabetes on BBI is 1 unit of insulin for every 2 mmol/L increase in BG over the target level. Figure 8 illustrates a scale (based on a correction factor of 2 mmol/L) that may be suitable for the IT initiation period for people with type 2 diabetes. It will need to be refined and individualized along with the baseline doses, but its use makes the transition to IT better and easier from the start. This type of scale would be suited for a person with a total daily dose of 50 units. A person with a TDD of 30 units may require a more conservative scale based on a correction factor of 3 mmol/L. Clinical judgement is used to individualize a scale. ● The “1800 Rule” is often used to calculate a supplement or correction bolus (123).