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PROBLEM SOLVING AND EXERCISES<br />
Use the problems and exercises in<br />
B. Increase the daytime basal rate<br />
this section to help you reinforce and<br />
by 0.2 units per hour?<br />
strengthen what you have learned<br />
C. Set her alarm and check her<br />
about insulin adjustment. The more<br />
blood glucose level at 3 AM?<br />
experienced you become at spotting<br />
D. Give a bolus at 10 PM?<br />
problems and figuring out the answers,<br />
the more rewards you will enjoy from<br />
practicing basal-bolus insulin therapy!<br />
A – Choice C is the correct answer - the<br />
only way to find out what is happening<br />
to Sally’s blood glucose level during the<br />
Sally’s on Goal at Bedtime but Gets night is to test it at 3 AM. Choice A -<br />
High Readings in the Morning<br />
Increasing the basal rate overnight might<br />
Sally has been using an insulin pump for cause hypoglycemia in the middle of the<br />
3 months. Her basal rate is set at 0.7 night. Choice B - Increasing her daytime<br />
units per hour from 10 PM to 3 AM and basal rate would do nothing to help the<br />
her daytime basal rate is 0.5 units per overnight blood glucose levels. Choice D -<br />
hour. She has been going to bed with Giving a bolus at 10 PM could cause a<br />
normal blood glucose values but always problem with hypoglycemia at midnight.<br />
wakes up with blood glucose levels over<br />
165 mg/dl. She increased her basal rate<br />
from 10 PM to 3 AM from 0.6 to the<br />
current rate of 0.7 units per hour but<br />
is still having a problem.<br />
Q – What should Sally do if she<br />
checks her blood glucose at 3 AM<br />
and discovers that it was 60 mg/dl?<br />
A. Lower the 10 PM to 3 AM basal rate?<br />
B. Eat a big snack at 10 PM?<br />
Q – What should Sally do to try to C. Decrease the snack bolus?<br />
bring her morning blood glucose level D. Increase the 10 PM to 3 AM basal rate?<br />
to her goal range of 90-130 mg/dl?<br />
A. Increase the basal rate from<br />
10 PM to 3 AM?<br />
A – Choice A is the correct answer.<br />
Sally has pattern D.<br />
Figure 5<br />
Patterns of Overnight Blood Glucose Values<br />
Blood Glucose<br />
400<br />
300<br />
200<br />
100<br />
0<br />
Bed 3 AM<br />
Time<br />
A B C D E F<br />
Fasting Bed 3 AM<br />
Time<br />
Fasting Bed 3 AM<br />
Time<br />
Fasting Bed 3 AM<br />
Time<br />
Fasting Bed 3 AM<br />
Time<br />
Fasting Bed 3 AM<br />
Time<br />
Fasting<br />
45
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