Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-60

Evaluate doses systemat ically by t ime/meal periods It is practical to divide analysis of insulin doses into “time/meal testing periods,” where a concentrated amount of data recording is done for one period at a time and food and activity for that period are kept as consistent as possible for two to three days. Ideally, assessments can start under the following conditions: blood sugars are between 5 and 10.0 mmol/L, no correction bolus has been taken within the past four hours, there has been four to five hours since a meal bolus and there has been no hypoglycemic events. Stop the evaluation if hyperglycemia or hypoglycemia occurs. • Assess the overnight period first by checking the glucose level at bedtime, at 1:00 AM, 3:00 AM or 4:00 AM and in the morning before breakfast or by using CGM or FGM. The goal is to find the dose that keeps the glucose level stable from bedtime to morning without causing a low or resulting in an elevated fasting level. Overnight control is often the most difficult to achieve. o Nightmares, restless sleep or complaints of headache, wet pillow or sheets on waking may be signs of sleeping through a low BG reaction. Asymptomatic nocturnal hypoglycemia is far more common than previously believed, but it may be difficult for people to accept this fact. It is estimated that people could sleep through a nocturnal hypoglycemic episode as often as 30% of the time (13,127).

Overnight assessment: Start four hours after dinner bolus. Date/Time CHO intake at dinner BG BG bedtime

BG 3 AM

BG Wake up

4 hours after dinner bolus

Day 1 Day 2 Adapted from Animas Insulin Pump Workbook (2008) (128)

Some people also assess their CIR at dinner on the day of their overnight assessment Date/Time BG

CHO Amount Low Fat No alcohol No exercise

BG 2 hrs after dinner

BG 4 hrs after dinner

BG bedtime

BG 3 AM

BG Wake up

Before dinner

CIR = carbohydrate to insulin ratio; CHO = carbohydrate Adapted from Animas Insulin Pump Workbook (2008) (128)