If a diabetic experiences problems in glucose control, then adjustments can be made to the insulin therapy regimen.
measure early AM glucose (see below)
decrease bedtime insulin (NPH or insulin glargine)
increase rapid-acting insulin at breakfast or morning NPH
decrease rapid-acting insulin at breakfast or morning NPH
increase morning NPH or increase rapid-acting insulin at lunch
decrease rapid-acting insulin at lunch
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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Purpose: To adjust the insulin dose for a patient with a problem with glucose control.
Specialty: Endocrinology, Clinical Laboratory
Objective: dosage adjustments
ICD-10: R73.0, T38.3,