3614-BD Insulin Adjust Workbook

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2. Absorption of Insulin ❑ Are your injection sites lumpy or scarred? ❑ Do you have any redness around your injection sites? Are you having trouble with your insulin pump infusion site or are you injecting in a scarred area? (This could affect how your body is absorbing the insulin and can lead to problems with control.) ❑ Have you changed how you give insulin? ❑ Have you changed the brand of syringe or size of insulin needle? ❑ If you are using an insulin pump, is the tubing clogged? 3. Stress ❑ Are you experiencing unusual stress? ❑ Did you know both physical and emotional stress could affect your blood glucose levels? 4. Infection ❑ Do you have an infection? ❑ Did you know infections are a stress to the body and can increase blood glucose levels? 5. Illness ❑ Are you ill? Do you have a fever, a cold, or a virus? ❑ Did you know illness could increase blood glucose levels? 6. Physical Activity ❑ Have you changed your physical activity a lot? ❑ Are you more or less active than usual? (If so, this can increase or decrease your blood glucose levels) 7. Food ❑ Are you eating more carb and not taking enough insulin? ❑ Is it possible you are not counting your carbohydrates accurately? ❑ Are you eating at the same time of day or does it vary? ❑ Are you eating less and taking too much insulin? 8. Self-Monitoring of Blood Glucose and Test Strips ❑ Are your test strips outdated or have the strips been outside the vial? (This will make your glucose readings inaccurate.) ❑ Are you checking at the right time of day to understand the effect of your insulin, food and physical activity? ❑ Did you clean your hands before checking your blood glucose? Even small amounts of food residue can affect results. If you answered YES to any of the above questions, correct the problem, give yourself a few days and see if your blood glucose levels out. If you answered NO to all of the above questions, your next step is to sort through your insulin doses. 41
Which Insulin is the Problem? 1. Basal Insulin ❑ Am I taking enough or too much basal insulin? ❑ Are my blood glucose levels always too high or too low? 2. Bolus Insulin ❑ Is my bolus insulin dose correct? ❑ Are my blood glucose levels too high or too low 2 hours after eating? 8 AM 12 noon 6 PM 10 PM BG Ins BG Ins BG Ins BG Ins Day 1 94 10 L 104 8 L 205 13 L 150 1 LP 19 G Day 2 108 10 L 103 8 L 197 13 L 155 1 LP 19 G Day 3 97 10 L 112 8 L 215 14 L 125 19 G Now, read the questions below and circle the letter that you think is the correct answer to each question. 1. What is the problem? A. Blood glucose too low at breakfast? B. Blood glucose too high at lunch? C. Blood glucose too high at supper? D. Blood glucose too low at bedtime? Read the following problem and see if it can help you figure out your basalbolus questions. Sam takes 19 units of insulin glargine (Lantus ®) at bedtime and insulin boluses of insulin lispro (Humalog) in the following amounts: 10 units for breakfast; 8 units for lunch, and 12 units for dinner. His mealtime carb amounts are 75 at breakfast; 60 at lunch; and 100 grams at dinner. His insulin/carb ratio is 8:1 and his correction dose is 1 unit for every 50 mg/dl and his target glucose is 100 mg/dl. On days 1-3 he always eats his normal amount of carb. He does not eat an afternoon snack. Look at his blood glucose values and insulin doses in the chart below. 2. Which of the following types of problems does Sam have? A. A basal problem? B. A bolus problem? C. An eating problem? 3. What should Sam do? A. Change the basal insulin glargine? B. Change the breakfast bolus? C. Change the lunch bolus? D. Change the supper bolus? 42
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 and 18: Q&A PRACTICE PROBLEMS Q - What is t
Page 19 and 20: ange without any insulin changes. A
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: TROUBLESHOOTING Sometimes you may f
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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