Basal Insulin Dosing
Bolus Insulin Dosing
Insulin doses should be adjusted every 1 to 3 days by 10% to 20% according to the patients blood glucose values to achieve effective in-target blood glucose control (5-10 mmol/L).
If the patient's fasting glucose in the morning is consistently high (above 8 mmol/L), the qhs basal dose should be increased by 10% to 20%.
If a recurrent correction dose is needed at a given meal due to a consistently elevated blood glucose, then the correction dose amount should be added to the PREVIOUS meal's bolus dose!
If a patient develops hypoglycemia (blood glucose < 4 mmol/L), use hypoglycemia protocol, treat with 15g of carbohydrate (4 dextrose tabs or 3/4 of a cup of juice or pop) and recheck the blood glucose in 15 minutes. Discuss the situation surrounding the hypoglycemic event with the patient. Were there diet or activity discrepancies to account for the low blood glucose? Was there a medication dose or administration error? If so, work to correct these issues. If there is no identifiable cause of hypoglycemia, reduce the preceding meal's bolus dose by 10% to 20%. If hypoglycemia occured overnight, reduce the bedtime basal dose by 10% to 20%.