Adjusting Insulin (MDI): based on blood glucose patterns
If your T1D child's blood sugar swings wildly, or is low at the same time each day (or high!) you may need to adjust insulin doses. But which dose, and how much? Looking for patterns in the numbers in your child's log book is a great place to start. Here we give you 3 easy steps for adjusting insulin within a Basal-Bolus/MDI Program (using long-acting for background insulin + rapid-acting insulin for food). We'll show you what to look for and how to tweak things from there.
Before Reading This Article...
If you have not done so already, we recommend that you first read How Insulin Action Impacts Blood Glucose in an MDI Program as background information for what follows.
Pattern Adjustment in 3 Easy Steps
In order to detect a pattern of high or low blood glucose, it is necessary first to know your child’s target blood glucose. Once you know what the goal is, you are ready to start down the path to reach that goal.
It may seem a little intimidating to make changes to the insulin doses your child is receiving. However, if you choose to make insulin adjustments, the process is relatively straightforward:
1. Review the log book every 3 to 4 days, looking for patterns.
2. If blood glucose is below the target range at the same time of day, for 2 days in a row...
... you may need to decrease the insulin that is working at that time.
3. If blood glucose is above target at the same time of day, for 3 days in a row...
... you may need to increase the insulin that is working at that time.
By How Much Should I Adjust?
The amount that you change the dose depends on how much insulin is currently being given.
|less than 5 units||then adjust by||1/2 unit|
|5 - 15 units||then adjust by||1 unit|
|16 - 30 units||then adjust by||2 units|
|greater than 30 units||then adjust by||3 - 4 units|
Tip from the Trenches
We have found that a pattern of highs or lows “jumps out” at us if we use a colour coded system in the log book: when we write in a high reading, we use red ink; low readings are logged in blue; target readings are written in black. Rather than keeping 3 pens hanging around, consider buying a pen with 4 colours in one barrel (Bic makes one). Or trying using pink and blue highlighters to draw attention to high and low readings. ~Michelle and Danielle
Other Notes about N/NPH Pattern Adjustment:
More detailed information + practice exercises:
An excellent Insulin Adjustment resource that we would encourage you to visit is provided online by BC Children’s Hospital: an insulin adjustment self-learning program is provided in a series of modules which take you through the principles and process of Insulin Dose Adjustment, covering all the relevant background information, as well as that specifically relating to pattern insulin adjustment (in Modules 1 and 2).
The above information was adapted with permission from The Alberta Children’s Hospital Diabetes Clinic information handouts.
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.
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