3614-BD Insulin Adjust Workbook

Q – What is Different About Tom’s Three-day Blood Glucose Pattern?
Pre-meal goals 90-130 mg/dl Post-meal goals < 180 mg/dl
Day # Breakfast Lunch Dinner Bedtime 3 AM
Pre Post Pre Post Pre Post
1 – Mon 90 125 110 239
2 – Tues 75 134 116 73
3 – Wed 100 141 131 266
Average 88 133 119 193
A – In this record, the breakfast, lunch
and dinner values are in the goal range.
However, the bedtime values are not
only too high on average, but also too
variable. Tom needs to look for and
understand what caused the low value
of 73 at bedtime on Tuesday.
Any time you see a consistent pattern of
either high or low blood glucose levels
over a period of three days, you could
adjust your insulin as follows. Either
increase the appropriate insulin if your
blood glucose levels are too high, or
decrease it if your blood glucose levels
are too low.
REMEMBER:
Most of the time, the appropriate insulin
to adjust is the rapid or short-acting
insulin taken at the meal before the
“out-of-goal” values.
• The change should be only 1 or 2
units or 10% of the usual dose at
that time of day and can be as small
as 1/2 unit.
• You can make changes every three
days.
• Make a change, evaluate the effect
for a few days and then make a
change again. You do not need to
make big changes. (When blood
glucose values are quite variable,
extra caution is needed because
making even a small change in insulin
under these conditions might be
dangerous).
HINT: Sometimes it is too early for you
to see a real pattern. In this case you
should probably not make any changes
and wait a few more days to see if a
pattern emerges. Or, by waiting a few
days you might find that your blood
glucose levels came back into the goal
15