Insulin Sensitivity Factor (ISF / Rule of 1800) Calculator
The **Insulin Sensitivity Factor (ISF)** — also called the *correction factor* — estimates how many blood-glucose (BG) points 1 unit of rapid-acting insulin will drop. It is the foundational tool for correcting hyperglycaemia in type-1 diabetes (and some insulin-treated type-2). **Classical rules**: (a) **Rule of 1800** (rapid analogues — lispro, aspart, glulisine, fast aspart, Lyumjev): ISF (mg/dL) = 1800 ÷ TDD; (b) **Rule of 100** (rapid, mmol/L): ISF (mmol/L) = 100 ÷ TDD; (c) **Rule of 1500** (regular "R" human insulin, slower kinetics): ISF (mg/dL) = 1500 ÷ TDD; (d) **Rule of 83.3** (regular R, mmol/L). TDD = total daily insulin dose (basal + bolus). **Correction dose = (current BG − target BG) ÷ ISF**. Enter TDD, insulin type and BG unit to get ISF; optionally add current / target BG for the correction dose. **Caveat**: this is a *starting-point* estimate (Walsh & Roberts, *Pumping Insulin*); real ISF varies with stress, illness, exercise, menstrual cycle, puberty and time of day, so **all changes must be reviewed by a clinician and verified with CGM data**.
Enter a valid TDD (0–500 U/day); BG values must be > 0.
ISF — BG drop per 1 U of insulin
2.0
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Correction bolus (U, estimate)
3.2 U
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Formula
Rapid analogue (lispro, aspart, glulisine, fast aspart, Lyumjev): ISF (mg/dL per 1 U) = 1800 / TDD ISF (mmol/L per 1 U) = 100 / TDD Regular "R" human insulin (slower kinetics): ISF (mg/dL per 1 U) = 1500 / TDD ISF (mmol/L per 1 U) = 83.3 / TDD (= 1500 / 18.0182) TDD = total daily insulin dose (basal + bolus + corrections, U/day) Conversion: 1 mmol/L = 18.0182 mg/dL for glucose Correction bolus: U_correction = max(0, (current_BG − target_BG) / ISF) Example (rapid, TDD = 50 U, mmol/L): ISF = 100 / 50 = 2.0 mmol/L per 1 U Current 14 mmol/L, target 6 mmol/L: Correction = (14 − 6) / 2.0 = 4.0 U
- · **Origins of the "Rule of 1800"** — proposed by John Walsh and Ruth Roberts in *Pumping Insulin* (1st ed. 1989, current 6th ed. 2017) based on statistics from hundreds of T1D pumpers and CGM users. The original was the **Rule of 1700** (regular R era); after rapid analogues (lispro, 1996) it was revised to **1800**. The **ADA 2024 Standards of Care §9** endorses the 1800 / 1500 rules as a starting point, with CGM time-in-range data driving subsequent titration.
- · **ISF varies strongly by time of day** — the dawn phenomenon (growth hormone + cortisol surge 04:00–08:00) *lowers* ISF 20–30 %, so a 50-U-TDD patient needs more insulin per BG point in the morning. **Typical multi-segment ISF profile**: morning ISF × 0.7, lunch × 1.0, dinner × 1.1, overnight × 1.2. Modern pumps (Medtronic 670G, Tandem t:slim X2, Omnipod 5) support up to 8 time-segment ISF settings.
- · **Computing TDD correctly**: include (a) **basal insulin** (glargine, degludec, detemir — or pump basal rate × 24 h); (b) **meal boluses** (rapid, per meal); (c) **correction boluses**. **Exclude**: emergency DKA boluses, ketogenic correction. **Newly diagnosed patients** start at ~0.5 U/kg/day (children) to ~1.0 U/kg/day (adolescents, obese, resistant) — a 50 kg adult → TDD 25–50 U. **Stable patients** use the rolling **14-day mean** TDD.
- · **Rapid vs regular R insulin — why the denominators differ (1800 vs 1500)**: rapid analogues peak at 1–2 h and last 3–5 h; regular R peaks at 2–4 h and lasts 6–8 h. "Per 1 U, the *sustained* effect of regular R drops BG more over its full window than 1 U of rapid", so regular R has a *smaller* ISF (more BG drop per U), reflected by the denominator falling from 1800 to 1500. Modern T1D management is overwhelmingly rapid + CGM; regular R is mostly an initiation option for type-2 after oral failure.
- · **Insulin On Board (IOB) is the critical correction**: rapid insulin lasts 3–5 h, so if the previous bolus is still active (IOB > 0), the correction must subtract the BG drop IOB will still deliver — otherwise you stack hypos. **Corrected formula**: U = max(0, (BG_current − BG_target) / ISF − IOB). Every modern pump computes IOB and warns you to "reduce bolus". This tool is a *simplified* educational starting point and **does not** subtract IOB.
- · **Over-correction → hypoglycaemia is the classic sign of a wrong ISF**: rules (a) if three consecutive corrections trigger BG < 4.0 mmol/L (72 mg/dL) within 4 h → ISF is too small (raise the denominator from 1800 to ~2000); (b) if 4 h post-correction BG is still > target + 3 mmol/L → ISF is too large (denominator 1600 — or audit IOB and insulin resistance); (c) only adjust after 3 *consistent* failures in the same direction — never react to a single event.
- · **References**: (1) Walsh J, Roberts R, *Pumping Insulin*, 6th ed., Torrey Pines Press (2017); (2) American Diabetes Association, "Standards of Care in Diabetes — 2024", *Diabetes Care* 47(Suppl. 1), §9; (3) Davidson PC et al. (2008), "Insulin-to-Carbohydrate Ratio and Insulin Sensitivity Factor in Adults with Type 1 Diabetes", *Endocrine Practice* 14(9):1095; (4) Battelino T et al. (2019), "Clinical Targets for Continuous Glucose Monitoring Data Interpretation", *Diabetes Care* 42(8):1593; (5) Kuroda A et al. (2012), "Basal Insulin Requirement Is 30–40 % of Total Daily Insulin Dose in Type 1 Diabetic Patients Who Use the Insulin Pump", *Diabetes Care* 35(7):1419.
Frequently asked
My TDD is 60 U/day on rapid lispro — what should my ISF be?
**Rule of 1800 / Rule of 100**: (a) **mg/dL**: ISF = 1800 ÷ 60 = **30 mg/dL per 1 U**; (b) **mmol/L**: ISF = 100 ÷ 60 ≈ **1.67 mmol/L per 1 U**. **In practice**: if your BG is 14 mmol/L (252 mg/dL) and target 6 mmol/L (108 mg/dL): (i) drop needed = 14 − 6 = 8 mmol/L; (ii) correction = 8 ÷ 1.67 ≈ **4.8 U**. **But subtract IOB** — if you bolused 6 U of lispro 90 min ago, ~3 U is still on board (linear 5-h decay), which will still drop you 3 U × 1.67 = 5 mmol/L. The true correction may be only ~1.8 U. **Caveat**: 1.67 mmol/L is only a *starting point* — your endocrinologist will tune it from CGM data (target: time-below-range < 4 %). Within a single day, real ISF for T1D can swing 0.7×–1.3×.
Why does my morning correction dose under-shoot but afternoon doses work fine?
**The dawn phenomenon is the usual culprit** — between 04:00 and 08:00, growth hormone, cortisol and catecholamines naturally rise, increasing *hepatic insulin resistance* and glycogen output. Real morning ISF runs **20–30 % lower** than afternoon: (a) baseline ISF (e.g. 1.67 mmol/L / U) → morning ISF ≈ 1.2 mmol/L / U; (b) the same 8 mmol/L drop needs ~6.7 U in the morning vs ~4.8 U in the afternoon. **Fixes**: (a) **pumpers**: set time-segmented ISF (00:00 → 1.4 mmol/L / U → 04:00 → 1.2 → 12:00 → 1.67 → 18:00 → 1.8); (b) **MDI users**: split-segment basal insulin (1–2 U NPH at midnight, or move to degludec for flatter 24-h coverage); (c) **automated insulin delivery (AID) systems** (Tandem Control-IQ, Omnipod 5) auto-tune basal every 5 minutes and largely neutralise dawn rise; (d) **lifestyle**: a 10-minute light walk 30 min before breakfast can cut morning resistance ~10–15 %.
What is the difference between ISF and ICR (insulin-to-carb ratio)?
**Both deliver rapid-insulin doses, but for different reasons**: (a) **ICR (insulin-to-carb ratio)** covers *food*: ICR = 500 / TDD (Rule of 500 — rapid) or 450 / TDD (regular R). E.g. TDD 60 U → ICR = 500/60 ≈ 8.3 g carb per 1 U. An 80 g-carb meal → meal bolus = 80 / 8.3 ≈ **9.6 U**. (b) **ISF (insulin sensitivity factor)** covers *high BG correction*: ISF = 1800 / TDD (rapid, mg/dL). E.g. TDD 60 U → ISF = 30 mg/dL / U. (c) **Total bolus = meal + correction** = 9.6 + 4.8 ≈ **14.4 U**. **Note**: both derive from the same TDD, so they must be re-tuned *together* — never change ICR without re-checking ISF. This tool focuses on ISF; pair it with the Carb-to-Insulin Ratio Calculator for the full meal-time picture.
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