Insulin Dose Adjustment

Insulin dose adjustment in steps

adjusting insulin dose pages from DAFNE

Introduction
Metabolic control Insulin
QA = quick-acting insulin
long-acting insulin
injection sites, absorption
food and insulin dose
carbohydrate count & portion = CP snacks
step-wise approach
hyperglycaemia
Physical exercise
links Illness (link)
hypos Hypos (link)
alcohol Driving (link)
abbreviations simulations

Identify the problem
Exclude other causes
Which insulin is responsible?
Which ratios are being used?
What background dose is being used?

You will need to be able to adjust your insulin dose to suit your requirements. Testing your blood glucose level is your best guide. Learning to adjust the dose is not easy, as not everyone needs the same dose. The DAFNE course helps you learn about your own requirements.

more quick-acting insulin per carbohydrate portion is needed at different times of the day
for example, at breakfast we recommend 1-3 units of quick-acting insulin for every carbohyrate-portion
at other times 1-2 units would be more usual
this is just a guide...it takes time to work out the does you need
the long-acting insulin rates need to be adjusted before the mealtime/quick-acting adjustments are calculated

Identify which blood glucose reading is out of target

pre-breakfast 5.5 - 7.5
pre-other meals 4.5 - 7.5
pre-bed 6.6-8.0

Exclude other causes such as:

carbohyrate-portion estimation, snacks, alcohol, physical activity
injection site/technique, over-treated hypo
incorrect ratio used, under/over corrected insulin

continue to monitor for 48 hours to see if there is a pattern
exception is a night time hypo, in which case long-acting insulin should be reduced the following evening

Which insulin is responsible?
Which ratios are being used?
What background dose is being used?
consider the onest, peak, and duration of insulin, and time between injections
high/low 2-4 hours after a meal..... generally quick acting
lots of lows/highs at these times...... could be long-acting
anytime more than 4 hours after a meal.....long-acting eg night, before supper (or exercse/illness/stress etc)

which insulin?	onset	peak	duration
NovaRapid, Humalog, Apidra	5-15 minutes	50-90 minutes	2-5 hours
Levemir	2 hours	4-6 hours	8-14 hours
Lantus	2 hours	no distinct peak	up to 18-24 hours

adjust the relevant dose

adjust one insulin at a time
long-acting by 1-2 units (approx 10-20%)
or
adjust quick-acting/carbohydrate portion ratio by 0.5

Continue to monitor and record readings to check the adjustment has been effective.