Table 6.
Examples of prandial insulin adjustments for a 45-year-old man (body weight 64 kg) receiving a total daily insulin dose of 40 units
| Case scenario | BG (mg/dl) | Interpretation | Problem areas | Suggested actions |
|---|---|---|---|---|
| Scenario 1 |
105 (BBF) 195 (ABF) 155 (BL) |
1. ABF not in target range 2. ABF–BBF > 40 mg/dl |
1. Quantity and quality of carbohydrate in breakfast 2. Insulin injection technique 3. BBF insulin dose 4. Insulin–meal gap |
1. Review quantity and quality of carbohydrate in breakfast 2. Educate patient on proper insulin injection technique 3. Increase BBF dose of regular insulin 4. Ensure 30-min gap between regular insulin and breakfast |
| Scenario 2 |
108 (BDN) 220 (ADN) 160 (BBF) |
1. ADN and BBF both not in target range 2. ADN–BBF > 40 mg/dl (indicates that dose of basal insulin is adequate) |
1. Quantity and quality of carbohydrate in dinner 2. Insulin injection technique 3. BDN insulin dose 4. Insulin–meal gap |
1. Review quantity and quality of carbohydrate in dinner 2. Educate patient on proper insulin injection technique 3. Increase BDN dose of regular insulin 4. Ensure 30-min gap between regular insulin and dinner |
| Scenario 3 |
105 (BDN) 95 (ADN)a – |
1. ADN < BDN and ADN < 100 mg/dl |
1. Quantity and quality of carbohydrate in dinner 2. Insulin injection site/other factors 3. BDN insulin dose 4. Insulin-meal gap |
1. Review quantity and quality of carbohydrate in dinner 2. Enquire whether BDN insulin was administered on thigh or if patient did some brisk walking or vomited or had diarrhea after dinner 3. Decrease BDN dose of regular insulin 4. Ensure that the gap between insulin and meal was not too long (> 30 min) |
For conversion from mg/dl to mmol/L, divide the value in mg/dl by 18
BG Blood glucose
aOn that night, patient should remain vigilant for hypoglycaemia (especially around 12–1 a.m.) and consume extra snacks or decrease basal insulin dose