Adjusting insulin dose.. glucose control
adjusting
insulin dose pages from DAFNE |
- What is good blood glucose control?
- glucose targets
- HbA1c (Gylcated Haemoglobin)
- Diaries
- How to test your blood glucose level
- When to test
- Testing for ketones
- Shift work
- Driving
What is good blood glucose control?
Good control of blood glucose is needed to
- feel well
- avoid minor infections caused by high blood glucose levels
- avoid severe hypos avoid diabetoketoacidosis
- to prevent / delay complications
- if pregnant to ensure a healthy baby
What is good blood glucose control?..'targets'
When your test your own blood glucose you need to aim for
- 5.5-7.5 mmol/l before breakfast
- 4.5-7.5 mmol/l before other meals
- 4.5-7.5 mmol/l 4 hours after meals
- 4.5-9.0 mmol/l 2 hours after meals
- 6.5-8.5 mmol/l before bed
This will keep blood glucose levels as near to the normal range as possible without causing problems such as hypos.
Occasionally, you may find that your blood glucose reading is high, e.g. 13 mmol/l. As long as you fell well and it returns to an acceptable level when corrected, this unlikely to cause any harm.
HbA1c (Gylcated Haemoglobin)
See Glucose sticks to the red blood cells and tissues of the body. The higher the blood glucose, the greater amount of glucose that attaches to the blood cells and tissues. The more glucose that is attached, the greater the risk of diabetic complications.
HbA1c measures the amount of glucose attached to the red blood cells The HbA1c gives a good guide to the blood glucose level over the previous 8-10 weeks. It is used as a measure of long-term measure of diabetic control. The usual result in someone without diabetes is 4.0-6.0%.
We believe the best result in diabetes is 6.0-7.0%. At this term most long term complications can be prevented, whilst at the same time avoiding severe hypos (hypoglycaemia). Below this level there is a higher risk of a bad hypos. Above this level here is an increased risk of complications. Before conception and during pregnancy, slightly lower levels are preferred.
The HbA1c is not the same as the average blood glucose nd is always slightly lower. For example, someone who has a blood glucose ~17mmol/l with have an HbA1c of ~13%.
Here is how they relate (and see convertor):
blood
glucose range mmol/l |
HbA1c |
under 7mmol/l (non-diabetic) |
less than 6% |
mostly under 10 mmol/l |
6-7% |
frequently over
10 mmol/l |
8-12% |
mostly over 17 mmol/l |
more than 13% |
Diaries
It is useful to record your blood glucose results in a diary, along with carbohydrate intake and insulin dosage, and exercise level. This is a way for you to monitor your control. It will help you choose the right dose of insulin in different situations and reflect on particular results. If you are outside the target range , you will need to adjust your insulin dose.
How to test your blood glucose level
Most people do not know what their actual blood glucose level is at any time purely by the way they feel, except in extreme situations (e.g. very high and low levels). Therefore, if you are aiming to keep your blood glucose level close to normal, you need to monitor it. Testing
When to test
You only need to test your blood glucose level if the result is to be used to make a decision. Self-monitoring is important to:
- find out your current blood glucose level
- recognise and avoid hypoglycaemia
- work out the dose of quick-acting insulin before meals
- help achieve ideal blood glucose control
Test your blood glucose each day
- before breakfast (or when you get up if you do not eat breakfast)
- before meals and snacks
- before bed
- before driving and every 90 minutes driving
- sometimes before and after exercise
- feeling unwell
- to confirm hypoglycaemia
Testing for Ketones
It is important to test for ketones when (see)
- blood glucose levels are consistently over 13 mmol/l
- any glucose reading is above 17mmol/l (even if this is unusual)
- if you fell unwell and have symptoms of diabetoketoacidosis
How to test for ketones
- always have testing strips at home ready to use
- use Ketostix testing strips dipping them in urine and then wait for 15 seconds and compare the colour to the chart
- there are also blood sensors that are useful
Shift work
This is a major challenge; ideally control your diabetes with regular shifts first before changing your shifts. It is much easier now with new insulins or pumps.
Driving
If you drive for your living you may have to compromise and have higher glucose levels. This is a decision you should make with your nurse and doctor. Unfortunately if you have high glucose levels they can damage your eyes and kidneys etc. HGV drivers have to give up their HGV licence if they need insulin.