Figure 2.

Insulin dose adjustments for adults using trend arrows in the FreeStyle Libre systems. Our recommended approach to adjusting insulin dose using trend arrow data in the FreeStyle Libre systems assumes that the patient has insulin-requiring diabetes, is using rapid-acting insulin for meals and correction, and is using insulin-to-carbohydrate ratio (ICR) and correction factors (CFs) that have been optimized as much as possible. The approach is based on anticipated glucose change and typical insulin sensitivity ranges in adults. The approach utilizes a simple approach to insulin dose calculation: Total insulin dose = food ± correction ± arrow adjustment. It provides adjustments in terms of insulin units over the range of insulin sensitivities to minimize additional calculations. It is generally recommended to start adjusting conservatively and at mealtime to understand how the recommendations impact individual glucose responses. Adjusting the insulin dose using trend arrows does not replace but, rather, adds to standard calculations using ICR and CFs. Importantly, a single arrow up may require additional corrections due to unknown velocity of glucose increase (e.g., >2 mg/dL). The CF (in mg/dL) indicates glucose lowering per unit of rapid-acting insulin. Conversion: mg/dL × 0.0555 = mmol/L.