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Administrating Insulin and Insulin Analogues

How to Adjust your Dose of Insulin

Introduction

One of the most important aspects of learning about insulin is knowing how to adjust your dose. In brief, raised blood sugars need a HIGHER dose of insulin and Low blood sugars need a LOWER dose of insulin. It is important to adjust doses on the basis of several results and not just one. This document will give you the necessary information on how to make safe and effective changes.

Once Daily Insulin

A single daily dose of basal insulin which provides a background level of insulin continuously throughout the day and night. If the pre breakfast blood sugar is raised, then increase your insulin dose.

If the pre-breakfast blood sugars are between 7-10mmols, then increase by 2 units, if 10 and above increase by 4 units. Allow 4-6 days before making further increases. If your blood sugars are too low, then reduce your insulin.

Aim for pre-breakfast blood sugar levels to be between 5-7mmols.

Twice Daily Insulin

Your morning dose of insulin controls your daytime blood sugar, before lunch and before your evening meal.

Your evening dose of insulin controls your blood sugar after your evening meal and overnight. If your teatime blood sugars are raised then increase your morning dose.

If your pre-breakfast blood sugars are high, then increase your evening dose by 2-4 units only.

Allow 3-4 days before increasing your dose further. If your blood sugars are above 15mmols increase by 4 units.

Generally you should aim for pre-meal blood sugars between 5-7mmols.  Blood sugar 2 hours after meal should be 9-10mmols.

Four Times Daily Insulin (Basal Bolus)

Your basal insulin taken once a day, which will usually be Insulin Glargine (Lantus) or Insulin Detemir (Levemir), controls your background blood sugar.  This dose of insulin does not usually need changing often.  However, if your blood sugar is either too high or too low during the night or up until pre-breakfast, then this insulin needs to be adjusted.

Breakfast insulin (usually Novorapid or Humalog) needs adjusting if your blood sugar mid morning or pre lunch is not in target range.

Lunchtime insulin (Usually Novorapid or Humalog) needs adjusting if your blood sugar mid afternoon or pre evening meal is not in target range.

Teatime or evening meal insulin (usually Novorapid or Humalog) needs adjusting if your blood sugar mid evening or before bed is not in target range.

Generally you should aim for pre-meal blood sugars to be between 5-7mmols and blood sugars 2 hours after a meal should usually be no higher than 9-10mmols.

If your blood sugars are 9-15mmols or above, increase your insulin by 2 units, if 15mmols or above, increase your insulin by 4 units at the appropriate time.

If you are ill

If you are unwell, you will need to follow the sick day rules. You can find these on www.diabetesuffolk.com or contact your GP, Diabetes Specialist Nurse or NHS direct on 0845 4647

Some do’s and don’ts

Do make small changes which are based on trends in your blood sugar patterns.

Do monitor your blood sugars for a couple of days after making any change.

Don’t adjust your insulin too frequently on the basis of your blood sugars.

Don’t omit your insulin because your blood sugar is within the normal range.

 

Liz Hartley – Diabetes Specialist Nurse
Nishan Wijenaike – Consultant Physician
West Suffolk Hospitals NHS Trust
Bury St Edmunds
January 2006