Could use some help with quiz

General
1

Hi all,

My son has gotten approved for a pump by the endo. She sent over a huge 15 page quiz to go over with him. MOst of it is insulin to carbs but some of the questions have to do with bolus which he has not done. I called her on it and she told him to do the best he can but I want to know what is correct and not what is close. The test is also 2 years old and some of the terminology is new. I figured if I knew the right answers I can compare it to what he does now to see if any different. 

Could use some help.

Here are a few questions. 

Assume 1 carb = 15 grams unless otherwise specified.

1. Your lunch consists of 4 carbs (60 grams). Your ratio is 1 u/CHO serving serving. How much insulin would you bolus to cover your carb choices: ________units. (I am not sure what 1 u/CHO means. 

Now he would give himself 4 units of Humolog.

2. For breakfast you have 3 carbs (45 grams). Your ratio is 1 u/10 grams CHO. How much would you bolus? (in units).

Now he would give himself 5 units of Humolog would it be different with bolus. 

3. You are taking 3 units for supper to cover the carbs you will consume. Your correction scale is :

150-22   +2u,    201-250 +3u, 251-300 +4u, over 300 +5u.

Your blood sugar is 117, how much insulin will you need to bolus in units?

4. Your basal rate is 0.9 u/hr. How much basal insulin will you receive in a day? in units

5. Your basal rate is 0.5 u/hr from 2 am until 6 am. The rest of the day it is 1 u/hr. How much insulin will you receive in a day in units.

6. Your insulin to carb ratio is 1u/CHO (15 grams). Your correction scale is BG greater than 150, add 0.5 unit for every 50 points ie: 150-200 + 0.5u, 201-250 + 1.0u, 251-300 + 1.5u etc.

Your am blood sugar is 173 and you are having 4 carb choices (60 grams) for breakfast. How many units total (Ratio plus correction) will you need to bolus in units

At lunch your blood sugar is 116. You are going to eat 5 carbs (75 grams). How much would you bolus in units

At dinner your blood sugar is 347. You are slightly sick to your stomach so you are only going to eat 2 carbs. How much will you bolus. What else must you do? (I know check ketones).  

Thanks for the help

2

I find it so interesting that you get this when you are getting ready to get a pump. I am a big believer in not letting the pump be your brain, but it will do all the calculating once you have the settings put in -- which your endo office (diabetes educator) should help you with. And if you guys don't know this stuff yet (how to figure ratios, corrections, etc.) -- which I'm guessing you do -- isn't that the fault of the endo office and lack of diabetes education???

Strange. Don't let this make you anxious about moving to the pump -- if your son understands when correction is needed (what his target range is) and how his bolus is figured (his ratio), then he will be fine on the pump.

Good luck!

3

First of all ***YEAH on getting approved for pump!!!!! ****

Our endo clinic had a similar thing (though fewer pages and one that was supposed to be filled out by my 4 yr old son (Ahh, he can't read!?!? It was dumb.)

Anyway, our CDEs told us it was because some people are coming from different ways of managing diabetes, like with different insulins and set eating schedules, but that moving from MDI (with a long-acting (Levemir/Lantus) and a short-acting (Novolog/Humolog)) you are already counting carbs the way that you will with the pump.

So converting the terminology is basal = your long-acting insulin now (Levemir/Lantus). However on the pump the basal rate is tiny amounts of shortacting insulin being given throughout the day. So for those questions - you'll just calculate how many hours at each rate and add them up. (e.g. If basal rate is 1.0 units/ hr , then the total basal insulin for the day is 24 units).

Bolus is the term for your short-acting insulin to cover meals (carbs) or corrections. So when they ask how much you would bolus, just figure out how much the shot of Humalog would be under the conditions described.

I won't do the quiz for you but here are my comments :)

From above #1. - Looks right to me..

#2 - I think the right answer is 4.5 units. (But the CDE will tell you how they want you to do that.) The pump can easily do fractions of units.

#3 - They are asking if you would give extra insulin for that BG? Would you?

Ketones question - They should help you with this one, but from our pump class, it was check for ketones before you eat, and then if they are present, you will have to alter (increase) the correction bolus.

4

Number 1 is right. 1 u/CHO means 1 unit per carbohydrate aka. read the directions above it