Diabetes Beginner

Adjusting Insulin Doses

Hey there! Today, we’re going to talk about how to adjust insulin doses for managing type 1 diabetes. Adjusting insulin might sound tricky, but with a little practice and guidance, you can do it! Let’s dive in.

When and How Should You Change an Insulin Dose?

  1. Look at Blood/CGM Glucose Patterns
    • Check your blood sugar or Continuous Glucose Monitor (CGM) readings over the past week.
    • Find out which insulin is acting during the high or low readings to make the right changes.
  2. Using a CGM
    • Sometimes, you’ll need to check your blood sugar with a finger-stick, especially if your CGM shows a very low or high reading.
    • Don’t use CGM for dosing if you’ve taken medicine with acetaminophen (like Tylenol), as it can affect the readings. This isn’t a problem with Dexcom G6 or Abbott FreeStyle Libre 2.
  3. Making Adjustments Based on Readings
    • If more than half of your readings are too high, increase the insulin dose acting at that time. If still high after three days, increase again.
    • If you have more than two low readings, decrease the insulin dose. If lows continue, decrease again.

Changing Insulin Dose Varies by Age

  1. For Small Children
    • Adjust doses by 0.05 to 0.5 units, especially when using an insulin pump.
  2. For Older Children and Teens
    • Adjust doses by 1 to 2 units.

Using Correction Factors

  1. Correction Factor
    • This is the number of insulin units needed to correct a high blood sugar to a target level.
    • Example: 1 unit of insulin for every 50 mg/dL (2.8 mmol/L) of glucose over your target.
  2. Adjusting Correction Factor
    • If blood sugars aren’t reaching target levels after corrections, you may need to change the correction factor.
  3. Timing and Dosage Adjustments
    • Wait at least 2 hours between correction doses to allow insulin to work.
    • Combine correction factors with insulin-to-carb ratios to figure out the total dose before meals and snacks.

Meal Boluses and Insulin Types

  1. Meal Boluses
    • Based on the carbs you’ll eat, use insulin-to-carb ratios.
    • Checking blood sugar 2 and 4 hours after meals helps manage levels better.
  2. Basal Insulin Adjustments (Lantus, Levemir, Tresiba)
    • Mainly based on morning fasting blood sugar levels.
    • If sugars are high or low overnight, adjust the basal dose accordingly.

Factors Influencing Insulin Dosages

  1. Things to Consider
    • Blood/CGM glucose level
    • CGM arrow direction
    • Illness (may need more insulin)
    • Exercise (may need less insulin)
    • Stress (may need more insulin)
    • Food (use insulin-to-carb ratio)
    • Menstrual cycle (may need more insulin)
  2. Time in Range
    • Aim for 70% of your blood sugar readings between 70-180 mg/dL (3.9-10 mmol/L).
    • Keep readings below 70 mg/dL (3.9 mmol/L) to less than 4%.

Remember!

It’s very important to adjust your insulin doses between visits if your blood sugar isn’t in range half the time or if it’s low more than 10% of the time. Your diabetes care team is always there to help if you have any questions.

By learning how to make these adjustments, you’ll get better at managing your diabetes and keeping your blood sugar levels in a healthy range. Keep practicing and stay in touch with your care team for support. You’ve got this!

Diabetes Beginner