Should people on insulin change their doses on their own?
Yes, if...
Definitely, yes, if they understand
which insulin to change, and the effects of meals and
exercise.
In fact, adjusting insulin doses is critical to successful
insulin pump
and
basal/bolus
insulin therapy.
Many doctors advise use of a "sliding scale" of short-acting insulin adjustments, based upon blood sugar levels before meals. We are uncomfortable with this concept, as it is "reactive" rather than "proactive." We
feel that other factors, such as the size of the upcoming meal
(especially dose adjustments based upon
carbohydrate counting)
and upcoming exercise effects are equally, if not more, important than the blood sugar level itself
(unless the patient is having symptoms of high or low sugar).
This proactive approach has been called "pattern control."
My general advice to my patients has been:
- Change one dose at a time
- Change two units at most
- Change only every three days (or less often) after you see a pattern developing.
- Change only if checking four or more blood sugars a day
- Call for advice if
you are having symptoms of high or low sugar, or if
these guidelines don't seem to work!
(Of course, there are exceptions to any guidelines, but it's unlikely that adult patients will go too far astray if
they use these guidelines.)
Also see
Standards of Medical Care for Patients With Diabetes Mellitus from the ADA.
"Patients should be taught how to use [blood glucose] data to adjust food intake,
exercise or pharmacological therapy to achieve specific glycemic goals."
Self-mixing insulin adjustments
(Copy of guidelines issued to patients
at Cumberland Infirmary Carlisle)
Carbohydrate Counting &
Insulin Adjustment
From Novo Nordisk.
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