Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-62

Afternoon: Start four hours after Date/ Time BG 4 hours after breakfast Start of assessment

BG Hour 1

BG Hour 2

BG Hour 3

BG Hour 4

Adapted from Animas Insulin Pump Workbook (2008) (128)

• Criteria: Basal insulin is being replaced adequately when the glucose level stays relatively steady, without changing more than 1.7 mmol/L, when not influenced by meal or correction boluses (i.e. a meal bolus has a major influence for approximately three hours). • Multiple basal rates are usual and expected in CSII therapy. A typical adult would have four basal rates per day; with the dawn period (3:00 AM to 8:00 AM) usually being the highest rate of the 24 hours and requiring a 10 to 20% higher rate (95). • Next, evaluate daytime meal doses/ratios by analyzing before meal and two and three hours after meal results: • An effective ratio will achieve a two and three hour BG within target ranges (although the ratio will not consider glycemic index of food). • Postprandial targets can be difficult to establish for some people, given the different rates of absorption and glycemic index of food. The 2018 Guidelines target for postprandial BG levels is 5 to 10 mmol/L — a broad range. The guidelines acknowledge that a postprandial target of 5.0 to 8.0 mmol/L may be required to achieve A1C goals of 7% or less (6). • Remember to consider the impact of the variables of insulin action, such as injection technique, site condition, insulin storage etc. and minimize this effect as much as possible. • Remember to consider the impact of variables in food quantity and quality, activity, stress etc. Discuss options for improvement other than insulin dose adjustments, if appropriate.