Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-73

Adjustments may be required over time, with recommendations not to adjust the basal dose by more than 0.1 unit/hour and no more than one insulin at a time (i.e. adjust only one basal rate, or the bolus, but not both). o When the basal dose is adjusted correctly, the patient can go for at least a five-hour period without food and with no more than a 1.7 mmol/L change in BG (134). The most common reason to adjust the basal rate is a need to increase the early-morning basal as a result of an in-target 3:00 AM BG followed by a high fasting BG, or a two-hour postprandial BG within target followed by high preprandial BG.

VARIATIONS IN SME WITH INSULIN PUMP THERAPY*

Comprehensive intensive diabetes education programs and materials are equally appropriate for BBI or insulin pump therapy and are described elsewhere (135-137). However, some modifications in self-management are required for pump users. *Training for health care professionals to become certified pump trainers is available. Inquire through local industry representatives. Notes on Pump Use Despite the many advances in the technology involving CSII and sensors there are several important points to consider: 1. The pump and sensor systems can be daunting to both new and previous pumpers. In order to get the best results our patients need to be encouraged to use all the functions available. In a recent study Kramer et al discovered that for various reasons many of the systems functions were not utilized. Kraemer et al studied metabolic control and hypoglycemia in a cohort of 237 people with type 1 diabetes. Their findings indicated that CSII and intensified insulin therapy had comparable metabolic control and treatment satisfaction but CSII was associated with higher incidence of non-severe hypoglycaemia and lower insulin dosage. Further analysis revealed only 33.3% of the pump users were using the advance functions available on the pump such as temporary basal rate reduction, various daily basal profiles and different bolus variations(96). 2. Pump and sensor use requires structured education sessions not only in the technical use of the systems but also in nutrition management. The REPOSE study showed some modest advantage in pump use with regard to reduction of AIC and increase in treatment satisfaction but stated educational support in the form of structured sessions and follow up is essential for successful use. (138).