Rationale of the Week | How much bolus insulin at each meal?
For last week’s practice question, we quizzed participants on how much basal bolus insulin at each meal. 50% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question
Answer Choices:
- 3 units
- 5 units
- 6-7 units
- More information is needed to determine bolus dose.
Question: KT weighs 60 Kgs and is newly diagnosed with diabetes and needs to start insulin therapy.
Based on the 50/50 rule for determining insulin dosing, which of the following is the most accurate bolus dose for each meal?
Getting to the Best Answer
Answer 1 is incorrect. 17% chose this answer. “3 units.” The 50/50 rule for insulin is a dosing strategy based on body weight. The formula looks like this; Take body weight is kg times 0.5 to get total daily needs per day. Then give 50% as basal and 50% as bolus insulin. The last step is to divide the bolus insulin by 3 meals to get the meal time bolus dose. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal.
Answer 2 is correct. 50% of you chose this answer. “5 units.” Yes, this is the BEST answer. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal. Super easy.
Answer 3 is incorrect. About 10% of respondents chose this. “6-7 units.” The 50/50 rule for insulin is a dosing strategy based on body weight. The formula looks like this; Take body weight is kg times 0.5 to get total daily needs per day. Then give 50% as basal and 50% as bolus insulin. The last step is to divide the bolus insulin by 3 meals to get the meal time bolus dose. Since KT weighs 60kg, here is how you do the math; 60kg x 0.5 = 30 units total insulin a day. 50% or 15 units is dedicated to basal insulin and 50% or 15 units is dedicated to bolus insulin. Now, divide the 15 units bolus insulin by 3 meals, which equals 5 units per meal.
Finally, Answer 4 is incorrect. 22.57% chose this answer. “More information is needed to determine bolus dose.” Although this is a tempting answer, it’s not the best answer since this is a straight forward dosing calculation problem. There is no information about their social determinants of health or any barriers. Given those facts, answer B is the best answer.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
Want to learn more about this question?
Recorded & Ready to Watch
Insulin Calculation Workshop | From Pumps & Beyond
Level 4 | Advanced Level & Specialty Topics
Determining basal & bolus rates for multiple daily injections or insulin pumps can seem overwhelming. This course provides participants with a step-by-step approach to determining basal rates, bolus ratios & how to problem-solve when blood glucose levels aren’t on target. During this course, Coach Beverly provides abundant case studies to give participants hands-on practice & build confidence when calculating insulin doses for a variety of situations.
Objectives:
- Describe using formulas to determine appropriate insulin dosing.
- Discuss strategies to determine & fine-tune basal insulin dose.
- Describe how to determine & fine-tune bolus rates including coverage for carbs & hyperglycemia.
- Using a case study approach, utilize calculations to determine the best insulin dosing strategy.
Learning Outcome:
Participants will have an increased knowledge of how to calculate bolus/basal insulin therapy based on person-specific factors and will be able to recommend insulin adjustments based on individual needs.
Target Audience:
This course is a knowledge-based activity designed for individuals or groups of diabetes professionals, including RNs, RDs/RDNs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other healthcare providers interested in staying up to date on current practices of care for people with prediabetes, diabetes, and other related conditions. The practice areas for RDs/RDNs for CDR reporting are healthcare, preventative care, wellness, and, lifestyle along with, education and research.
CDR Performance Indicators:
- 10.3.1
- 10.5.3
Instructor: Beverly Thomassian RN, MPH, CDCES, has been Board Certified in Advanced Diabetes Management for over 15 years. She is an Associate Clinical Professor at UCSF, a working educator, and a nationally recognized diabetes expert.
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Accreditation: Diabetes Education Services is an approved provider by the California Board of Registered Nursing, Provider 12640, and our CPEU courses have received Prior Approval* from the Commission of Dietetic Registration (CDR), Provider DI002. Since our CPEU courses received Prior approval* from the CDR, these CPEU courses satisfy the CE requirements for the CDCES /BC-ADM regardless of your profession!
The use of DES products does not guarantee the successful passage of the certification exam. CBDCE and ADCES do not endorse any preparatory or review materials for the CDCES or BC-ADM exams, except for those published by CBDCE & ADCES.
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