Guidelines For Insulin Initiation and Adjustment In Primary Care
Guidelines For Insulin Initiation and Adjustment In Primary Care
Guidelines For Insulin Initiation and Adjustment In Primary Care
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<strong>Guidelines</strong> <strong>For</strong> <strong><strong>In</strong>sulin</strong> <strong>Adjustment</strong> <strong>In</strong> <strong>Primary</strong> <strong>Care</strong>.<br />
<strong><strong>In</strong>sulin</strong> Dose <strong>Adjustment</strong> - Basal Bolus Regimen (4 <strong>In</strong>jections daily)<br />
Table 6<br />
Blood<br />
Testing<br />
Times<br />
Before<br />
Breakfast<br />
Before<br />
Lunch<br />
Before<br />
Evening<br />
Meal<br />
Before<br />
Supper/<br />
Bedtime<br />
Blood Glucose<br />
15mmol/l<br />
<strong>In</strong>crease<br />
bedtime<br />
intermediate<br />
insulin by 4<br />
units<br />
<strong>In</strong>crease<br />
morning short<br />
acting insulin<br />
by 4 units<br />
<strong>In</strong>crease<br />
lunchtime<br />
short acting<br />
insulin by 4<br />
units<br />
<strong>In</strong>crease<br />
Evening meal<br />
short acting<br />
insulin by 4<br />
units<br />
• <strong><strong>In</strong>sulin</strong> may need adjusting for exercise, meal composition, patterns in blood<br />
sugar levels, during illness <strong>and</strong> weight loss or gain episodes.<br />
• Do not adjust dose on a “single” raised blood glucose.<br />
• Adjust according to the chart above <strong>and</strong> monitor for at least 48 hours to judge<br />
the effect before further adjustment<br />
• Blood glucose target range should be set <strong>In</strong>dividually for each patient.<br />
• Dose adjustment is individual <strong>and</strong> needs to be monitored closely.<br />
• Patients should be educated to adjust their own insulin<br />
• Document change of insulin dose in the nursing notes.<br />
• If problems persist in controlling the blood glucose level seek advice from the<br />
General Practitioner or link Diabetologist.<br />
Reviewed January 2010 11
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