Do not adjust your insulin based on just one or two results unless you’ve had an unexplained hypo. Look for patterns and trends and identify any changes to diet and lifestyle.
Use this stepwise approach:
- What is the problem?
- Is it a regular problem?
- What might have caused the problem? (increased dietary intake, change of temperature, illness)
- What options will I try?
- During periods of illness refer to sick day rule guidance
When to monitor your blood glucose levels
You should monitor your blood glucose levels:
- before meals and bedtime
- when hypoglycaemia is suspected
- when feeling unwell
You also need to monitor glucose levels:
- at least two hours before driving
- every two hours on longer journeys
Insulin timings
- Take bolus (rapid acting) insulin five to 15 minutes before eating unless instructed otherwise.
- Take basal (long acting) insulin at the same time every day.
How to adjust your basal bolus insulin
Insulin doses should be reviewed every three to seven days rather than daily. The only exception is after an unexplained hypo (blood glucose below 4 mmol/L), in which case the relevant dose should be reduced the following day.
Do not increase both long acting and rapid acting insulins at the same time.
Adjusting long acting insulin
Blood glucose readings should be taken before breakfast for at least three days. If readings are not within target then adjust the insulin dose as below:
- Below target range – reduce dose by four units
- Within target range – continue same dose
- Above target range – increase dose by two units
Adjusting rapid acting insulin
Blood glucose readings should be taken before meals for at least three days. If readings are not within target then adjust the insulin dose as below:
- Below target range – reduce dose by four units.
- Within target range – continue same dose.
- Above target range – increase dose by two units.
When adjusting insulin, follow the specific times below:
- If blood glucose is high or low at lunchtime, adjust insulin at breakfast time.
- If blood glucose is high or low at evening meal, adjust insulin at lunch time.
- If blood glucose is high or low at bedtime, adjust insulin at evening meal.
Further information
Further formal education is available from Injectable Therapies, DAFNE and VICTOR programmes. Please contact your diabetes team for further information.
Having your long-term blood test (HbA1c) between 48 – 58mmol/mol reduces risk of long term complications such as:
- heart attack
- stroke
- changes to eye health/vision
- kidney function
- nerve damage (neuropathy)
If you are unwell you should seek advice from:
- your GP
- Practice Nurse
- NHS 24
- Diabetes Team
Contact
If you need further advice please call:
Diabetes Advice Service: 01563 827642 (Monday to Friday, 8.30am to 12pm)