3614-BD Insulin Adjust Workbook

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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
ange without any insulin changes. Always make insulin dose changes only after a full examination of the blood Based on your results, fill out the answers to the following questions: 1. Do you see a consistent pattern? ________________________________ 2. Which insulin is affecting the pattern of your glucose levels?_____________ 3. What kind of change might have helped bring your blood glucose levels into goal range?_____________ 4. Do you want to wait a few more days before you make any change to see if there really is a pattern?____________ 5. Have you experienced changes in your stress and/or activity levels over the past three days?_______________ 6. Have your food choices or amounts been different than usual for you? ________________________________ glucose levels and do it carefully! If you are unsure, consult with your Diabetes Team. Record Your Blood Glucose for the Past 3 Days and Pick Out the Patterns You See Pre-meal blood glucose goals:________ Post-meal blood glucose goals:________ Day # Breakfast Lunch Dinner Bedtime 3 AM 1 – Mon 2 – Tues 3 – Wed Average Pre Post Pre Post Pre Post 7. Are you experiencing hormonal changes (such as those during menstruation or perhaps related to any medication you may be taking)? ________________________________ 8. Is your pattern of values before breakfast out of the goal range?____ (If YES, this indicates that you need to change your basal insulin. Please refer to p. 37 for a discussion of this topic.) HINT: Some people find it easier to use a computer program to identify blood glucose patterns. If you are interested in this type of a program, contact your meter manufacturer for information on how to obtain one. 16
Page 1 and 2: TARGET THERAPY Staying on Target TM
Page 3 and 4: INTERACTIVE TABLE OF CONTENTS To go
Page 5 and 6: WHAT IS BASAL-BOLUS? When you have
Page 7 and 8: TERMS TO LEARN FIRST 4
Page 9 and 10: NOTE: For an algorithm to work you
Page 11 and 12: EXAMPLE: Calculating Laurie’s Cor
Page 13 and 14: MAKING BOLUS INSULIN CHANGES Your f
Page 15 and 16: Blood Glucose Monitoring: When to T
Page 17: Q&A PRACTICE PROBLEMS Q - What is t
Page 21 and 22: Ken’s Algorithm for Correction Me
Page 23 and 24: PRACTICE PROBLEMS: Blood glucose ta
Page 25 and 26: Fill in your pre-meal blood glucose
Page 27 and 28: If you had a “low blood glucose
Page 29 and 30: Method I: A Quick and Easy Way to S
Page 31 and 32: Method I - Insulin Dosing Based on
Page 33 and 34: PUTTING IT ALL TOGETHER 30
Page 35 and 36: Your Night Out - Using the Five Ste
Page 37 and 38: ADJUSTING THE BASAL INSULIN DOSE 34
Page 39 and 40: 7. Your graph should look like one
Page 41 and 42: Option II: See if your basal rises
Page 43 and 44: TROUBLESHOOTING Sometimes you may f
Page 45 and 46: Which Insulin is the Problem? 1. Ba
Page 47 and 48: PROBLEM SOLVING AND EXERCISES 44
Page 49 and 50: By lowering the 10 PM to 3 AM basal
Page 51 and 52: Juan Has Had a Change in His Blood
Page 53: SEE - YOU REALLY CAN DO IT! This wo

3614-BD Insulin Adjust Workbook

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