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Dr. Bill's Commentaries

Should people on insulin change their doses on their own?   (August 18, 2007)

Definitely, yes, if you understand which insulin to change, and the effects of meals and exercise. In fact, adjusting insulin doses is critical to successful insulin pump and basal/bolus insulin therapy.

Many doctors advise use of a "sliding scale" of short-acting insulin adjustments, based upon blood sugar levels before meals. I am very uncomfortable with this concept, as it is "reactive" rather than "proactive." Other factors, such as the size of the upcoming meal (especially dose adjustments based upon carbohydrate counting) and upcoming exercise effects are equally, if not more, important than the blood sugar level itself. This proactive approach has been called "pattern control."

My general advice to my patients has been:

Change one dose at a time
Change two units at most
Change only every three days (or less often) after you see a pattern developing.
Change only if checking four or more blood sugars a day
Call for advice if you are having symptoms of high or low sugar, or if these guidelines don't seem to work!

(Of course, there are exceptions to any guidelines, but it's unlikely that adult patients will go too far astray if they use these guidelines. Check with your physician: YMMV.)

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

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