Using Insulin Effectively

Insulin dose adjustment

This page deals with insulin dose adjustment for optimization of long-term blood glucose control

Background basics

Review first :
		the match of education, doses, meals, and activity to the Insulin, injections, and associated education box given above
		the individual’s perception and experience of hypoglycaemia and hyperglycaemia
Review section 13 ( below ) if hypoglycaemia problems
Ensure then that :
		the person with diabetes has confidence in your advice
		self-monitoring and HbA1c data are available to you, and are reliable
		you are familiar with the person’s life-style habits, in particular eating and activity patterns, and times of insulin injections
		injection skills and injection sites are in good order

Dose adjustment for different insulin preparations

Consider the previous two pages first
Short-acting unmodified insulin
	Consider :
	the median glucose level at the time of the injection to be adjusted the median glucose level at the time of the next injection the experience of hypoglycaemia or subnormal glucose levels ( <4.0 mmol/l; <70 mg/dl ) between the two injections
		if :
			glucose levels are high at the beginning of the relevant period
			review the insulin dose affecting the previous time period first
		Otherwise if :
			glucose levels are above target, and hypoglycaemia is not an issue
			increase insulin dose by 10 %; arrange to monitor and review result
		Otherwise if :
			hypoglycaemia is an issue or glucose levels <4.0 mmol/l ( <70 mg/dl )
			decrease insulin dose by 10 %; arrange to monitor and review result
		Otherwise if :
			no simple adjustment is possible; consider more complex adjustment, or accept the status quo
Rapid-acting insulin analogues
	Read the box on insulin analogues above
	Consider the median post-prandial ( 2-4 h ) glucose level / hypoglycaemia experience ( and not the next pre-prandial / pre-injection level )
	Proceed otherwise as for short-acting unmodified insulin ( see above )
Extended-acting NPH insulin at bed-time
	Consider
	the median glucose level at bed-time the median glucose level before breakfast any information on glucose levels during the night
	Adjust insulin dosage as for short-acting unmodified insulin ( see above )
Extended-acting NPH insulin at other times
	Consider
	the blood glucose profile over the 12 h after the injection the experience of hypoglycaemia or subnormal glucose levels ( <4.0 mmol/l; <70 mg/dl ) over the same time period the expected effect of other insulin used in the same time interval
	Adjust insulin dosage as for short-acting unmodified insulin ( see above )

Algorithm for insulin adjustment when glucose levels are above target

Algorithm for insulin adjustment when glucose levels are below target

The insulin algorithms on this page :

do not address the use of rapid-acting analogues

cannot cope with more complex regimens ( when two insulins are injected together )

should be used only in the context of the material on the previous three pages

Hypoglycameia Problems