500 rule

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500 rule for carbohydrates. Gives your " Insulin to Carb Ratio " or " Carb

Coverage Number " for those on multiple daily injections or an insulin pump.

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500 Rule For Carbs |

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The 500 Rule

A closer look

Gives your " Insulin to Carb Ratio " or " Carb Coverage Number " for those on

multiple daily injections or an

insulin pump

The 500 Rule (aka 450 Rule) from

Pumping Insulin

and the

Pocket Pancreas

is a great way to estimate how many grams of carbohydrate will be covered by

one unit of Humalog or Novolog insulin. It lets you balance the blood sugar

rise coming from carbs eaten in a meal (carbs cause about 90% of this rise)

with the blood sugar lowering action of your fast insulin. The 500 Rule:

estimates grams of carb per unit of Humalog or Novolog insulins (the 450

Rule is used with Regular insulin)

500 divided by your TDD (Total Daily Dose of insulin) = grams of carb

covered by one unit of Humalog or Novolog

Leys you keep your postmeal readings normal!

Example:

Someone's TDD = 50 units (ie, the total amount of say Humalog and Lente

insulins they used per day).

500/50 = 10 grams of carbohydrate covered by each unit of Humalog insulin

TDD = all fast insulin taken before meals, plus all long-acting insulin used

in a day. If Humalog is used everyday to correct high readings, this may

also

need to be factored into the TDD. For instance, if someone's TDD is " 30

units " (5 H before each meal, plus 15 Lantus at bedtime), but they need 8 to

12

units more almost every day to bring down highs, at least some of this 8 to

12 units will need to be factored into a new TDD.

Caution: The 500 Rule works best when someone is using MDI or an insulin

pump and is getting 50% to 60% of their TDD as L/N/UL/Lantus or in their

basal

rate.

Table with 3 columns and 11 rows

The 500/450 Rules

..

500 Rule

450 Rule

Total Daily

Insulin Dose

Grams of Carb

Covered by

1 Unit of Humalog

Grams of Carb

Covered by

1 Unit of Regular

20

25

23

25

20

18

30

17

15

35

14

13

40

13

11

50

10

9

60

8

8

Adapted from Pocket Pancreas, Copyright © 1994, Diabetes Services, Inc.

table end

Caution: This Rule works best for those with Type 1 diabetes who have no

insulin production. With Type 2 diabetes, there is usually extra internal

insulin

production plus resistance to insulin. Although these factors make it harder

to know the exact " total insulin " (injected plus internally produced), the

result is that insulin doses may be underestimated in Type 2, giving lower

doses than actually needed.

A good control program uses blood sugar tests in an organized way to adjust

insulin doses. With your physician's help, long-acting insulin doses are

first

matched to your background insulin need. This keeps the blood sugar level

while fasting. Then the table can be used to estimate how many grams of

carbohydrate

will be covered by each unit of Humalog or Regular insulin. When someone is

using Multiple Daily Injections (MDI) or an insulin pump, the 500 Rule

provides

a good guide to how much Humalog or Novolog is needed to match

carbohydrates.

For those who are not using MDI but who take fast insulin for breakfast and

dinner, the Rule can be used as a rough guide to match the carbohydrate in

these

meals. But here, it's accuracy isn't as great as with true MDI, because some

long-acting insulin is actually covering some of the meal carbohydrates.