*4.1.6 Insulin regimens*

All persons with T1DM need a substitute of insulin that mimics normal insulin action. To mimic normal insulin action, rapid-acting (or short-acting) insulin is given before meals, and this is meant as bolus insulin. Bolus insulin doses are corrected based on the number of saccharide in the meal.

An insulin-to-saccharide ratio can be established for an individual that will guide determinations on the amount of mealtime insulin to infuse. Basal (Long-acting) insulin dose is the amount of insulin required in the post absorptive state to control endogenous glucose output primarily from the liver. Basal insulin also limits lipolysis and the surplus flux of free fatty acids to the liver. These physiologic insulin regimens allow added flexibility in the type and timing of meals.

For normal persons with T1DM, the required insulin dosage is about 0.5 to 1 unit/kg of body mass per day. About half percentage of the total daily insulin dose is used to provide for basal insulin needs. The remainder (rapid-acting insulin) is divided among the meals by giving about 1 to 1.5 units of insulin per 10 to 15 g of saccharide consumed. As a result of the presence of higher level of counterregulatory hormones in the morning, many individuals may require larger doses of mealtime insulin for saccharide consumed at breakfast than for meals later in the day. The type and timing of insulin regimens should be customized based on eating and exercise habits and blood glucose level [1].
