Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-63

Anticipatory dose adjustments Anticipatory or supplemental dose adjustments are temporary adjustments in insulin to compensate for planned changes in carbohydrate intake or activity level.

Meal-related adjustments Meal-related insulin adjustments can be made so that people do not always need to eat the same amount of carbohydrate. Rapid/short-acting insulin before the meal can be adjusted to accommodate the amount of carbohydrate of the meal. Usually, only the carbohydrate content of a meal is considered when deciding on an insulin dose. However, meals high in fat and protein may require additional insulin (see Nutrition, below). Some practitioners suggest that the timing of injection and meal intake may vary when BG levels fall outside of desired target range. They suggest that when BG tests are high before a meal, it may be best to inject and then wait for a short period, (i.e. 10-15 minutes), if possible, for blood glucose to decrease before ingesting carbohydrate (7380). As well, when BG is low, it might be best to delay injection slightly, or even inject after eating. Adjustments for planned act ivity Exercise requires appropriate adjustments to food and/or insulin to help prevent hypoglycemia during or after exercise. The amount of extra food or insulin reduction needed to prevent hypoglycemia varies for each person. The BG-lowering effect should be similar for the same activity of the same intensity and duration. Therefore, pattern-management principles can be used to evaluate adjustments (see Physical Activity/Exercise, below).