Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-56

Example : If BG = 14, target BG = 7, and CF =2 14 – 7 = 7 mmol/l ÷ 2 = 3.5 units as correction bolus This means that the person would administer 3.5 units by pump, pen or syringe (if using a ½ unit pen) to bring BG back to the target range. Remember, he/she will need this correction dose in addition to the usual dose for food. For example: Bob’s pre-lunch BG is 12.9 mmol/l. His usual baseline dose for lunch is 8 units and his correction factor is 2 mmol/l. He plans to eat his usual lunch (e.g. 70 g carbohydrate). How much rapid insulin does he need to give before lunch? Usual lunch insulin = 8 units Correction = 3 units Total lunch dose = 11 units Using the formula: current BG – target BG divided by CF: 12.9 – 7 = 5.9 = 2.95 2 2 Therefore Bob would add 3 units correction to his usual dose of 8 units for a total of 11 units. 2. Hypoglycemia indicates a need to take less insulin, but not to omit insulin. • Treat the low BG first and then take the lower dose of insulin as indicated by the scale and eat carbohydrate foods as planned. In general, 1-2 units less than the baseline dose is adequate to prevent further hypoglycaemia. • Treat a mild to moderate low BG with 15 g of carbohydrate, preferably as glucose or sucrose (e.g. glucose tablets, sugar or regular pop) (11). Use 20 g of carbohydrate as treatment of a severe low in a conscious person (11). • Treat the low immediately to avoid a severe reaction. • Use distraction techniques to avoid overeating until feeling better. Over-treating will lead to a high BG later. • Lower the dose of insulin that was responsible for the hypoglycemia by 1 to 2 units (or 10% if usual dose is >30 units), if you cannot identify the underlying cause (74). o Clinically, if the BG was in the 2’s, reduce by 20%. Remember that the baseline dose is effective only with the usual food and usual activity. Once the baseline dose has been established, fine-tuning the rest of the VIDS can take place using the same principles of pattern management.