. 2020 Jul 18;11(9):2177–2194. doi: 10.1007/s13300-020-00873-3

Table 8.

Examples of basal 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	154 (ADN) 60 (3 A.M.) 155 (BBF)	1. BBF not in target range 2. 3 a.m. hypoglycaemia	1. Missed or inadequate bedtime snack 2. Dose of basal insulin	1. Ensure adequate bedtime snack 2. Decrease dose of basal insulin
Scenario 2	158 (ADN) 140 (3 a.m.) 164 (BBF)	1. BBF not in target range 2. 3 a.m. > 100 mg/dl 3. ADN–BBF < 40 mg/dl	1.Quantity and quality of carbohydrate in bedtime snack 2. Insulin technique 3. Dose of basal insulin	1. Check quantity and quality of carbohydrate in bedtime snack 2. Educate patient on proper insulin injection technique 3. Increase dose of basal insulin
Scenario 3	142 (ADN) 94 (3 a.m.) 80 (BBF)	1. BBF 70–90 mg/dl 2. 3 a.m. < 100 mg/dl	1. Inadequate bedtime snack 2. Dose of basal insulin	1. Ensure adequate bedtime snack 2. Decrease dose of basal insulin
Scenario 4	114 (BBF)^a 142 (AL) 212 (BDN)	1. BDN not in target range 2. AL in target range	1. Quantity and quality of carbohydrate in evening snack 2. Dose of morning basal insulin	1. Review quantity and quality of carbohydrate in evening snack 2. Increase dose of morning basal insulin^b

Case scenario

BG (mg/dl)

Interpretation

Problem areas

Suggested actions

Scenario 1

154 (ADN)

60 (3 A.M.)

155 (BBF)

1. BBF not in target range

2. 3 a.m. hypoglycaemia

1. Missed or inadequate bedtime snack

2. Dose of basal insulin

1. Ensure adequate bedtime snack

2. Decrease dose of basal insulin

Scenario 2

158 (ADN)

140 (3 a.m.)

164 (BBF)

1. BBF not in target range

2. 3 a.m. > 100 mg/dl

3. ADN–BBF < 40 mg/dl

1.Quantity and quality of carbohydrate in bedtime snack

2. Insulin technique

3. Dose of basal insulin

1. Check quantity and quality of carbohydrate in bedtime snack

2. Educate patient on proper insulin injection technique

3. Increase dose of basal insulin

Scenario 3

142 (ADN)

94 (3 a.m.)

80 (BBF)

1. BBF 70–90 mg/dl

2. 3 a.m. < 100 mg/dl

1. Inadequate bedtime snack

2. Dose of basal insulin

1. Ensure adequate bedtime snack

2. Decrease dose of basal insulin

Scenario 4

114 (BBF)^a

142 (AL)

212 (BDN)

1. BDN not in target range

2. AL in target range

1. Quantity and quality of carbohydrate in evening snack

2. Dose of morning basal insulin

1. Review quantity and quality of carbohydrate in evening snack

2. Increase dose of morning basal insulin^b

For conversion from mg/dl to mmol/L, divide the value in mg/dl by 18

^aPatient being treated with twice daily basal insulin (bedtime and morning 9 am)

^bIn refractory cases, addition of short- or rapid-acting insulin before evening snack may be warranted