If a diabetic experiences problems in glucose control, then adjustments can be made to the insulin therapy regimen.
Blood Sampling
Problem Hyperglycemia
Problem Hypoglycemia
fasting
measure early AM glucose (see below)
decrease bedtime insulin (NPH or insulin glargine)
before lunch
increase rapid-acting insulin at breakfast or morning NPH
decrease rapid-acting insulin at breakfast or morning NPH
before dinner
increase morning NPH or increase rapid-acting insulin at lunch
decrease rapid-acting insulin at lunch
at bedtime
increase rapid-acting insulin at dinner
decrease rapid-acting insulin at supper
Fasting hyperglycemia may be due to insufficient insulin at bedtime or rebound to nocturnal hypoglycemia. These can be distinguished by an early AM glucose measurement.
(1) If the patient experiences early AM hyperglycemia, then increase basal insulin at bedtime.
(2) If the patient experiences early AM hypoglycemia, then decrease basal insulin at bedtime.
Adjusting rapid-acting insulin may involve adjusting the correction dose or the insulin-to-carbohydrate ratio.
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