Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-59

Figure 9. Guidelines for adjusting insulin according to blood glucose patterns: Sample patient handout

Know your blood glucose goals.

•

• Know the action of each of your insulins (onset, peak, duration) and the time of day that each insulin is working. • If your blood glucose results are not in the goal range, consider possible reasons for this (i.e. changes in activity or diet, stress, changes in injection sites or injection times, too much or too little insulin). • Adjust insulin doses based on patterns in your blood glucose. A pattern of at least 2 days should be apparent before changing your insulin dose (patterns are consistent trends in blood glucose that occur at the same time of day for at least two days in a row when everything else is the same). • After you have identified a pattern of high or low blood glucose, answer the following questions:

o When is your blood glucose outside of the goal range? o Is your blood glucose too high or too low at this time? o Which insulin has the most effect on your blood glucose at this time? o Does the insulin need to be increased or decreased? o Would it be more suitable to make changes to your diet or activity?

• Change the insulin that will have the most effect on the blood glucose that is out of your goal range. • Consider all blood glucose results that will be affected by changing an insulin. For example, if you change your rapid/short-acting insulin before breakfast, consider the effect it will have on both your after-breakfast and before-lunch glucose levels. • Adjust your insulin by 1 or 2 units at a time. • Always assess the effect of adjusting your insulin. Continue to check your blood glucose regularly after you have changed your insulin dose. • Usually you will need to change only one insulin at a time. Begin with the insulin that will help correct any low blood glucose results. If there is not a pattern of low blood glucose results and if several blood glucose readings are out of your goal range, fix the first problem blood glucose of the day first. For example, if your blood glucose is too high before breakfast and after breakfast, begin by adjusting your insulin to improve

your blood glucose before breakfast. © Leadership Sinai Centre for Diabetes