Publication Date: 11/12/2009
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!
