Insulin adjustment and problem solving

There are some general guidelines to help you to adjust your insulin doses and resolve problems with your blood glucose levels. These guidelines relate to 2 injections each day

You should only change insulin doses if there is a trend of three or more high or low blood glucose levels. It is important to only change one of the doses of insulin at a time and to wait for 2-3 days before making any further changes. If the blood glucose levels do not respond as you expected, please ring a member of the Diabetes Team for advice.

Problem	Solution
High blood sugar - Pre Lunch	Put am insulin up by 1-2 units
Low blood sugar - Pre Lunch	Put am insulin down by 1-2 units
High blood sugar - Pre Tea	Put am insulin up by 1-2 units
Low blood sugar - Pre Tea	Put am insulin down by 1-2 units
High blood sugar - Pre Bed	Put pm insulin up by 1-2 units
Low blood sugar - Pre Bed	Put pm insulin down by 1-2 units
High blood sugar - Pre Breakfast	Put pm insulin up by 1-2 units
Low blood sugar - Pre Breakfast	Put pm insulin down by 1-2 units
Low blood sugar - Pre Bed and during night then High Pre-Breakfast	Put pm insulin down by 1-2 units
Hypo - after or during exercise	Give extra sugary snack before exercise, extra starch afterwards and possibly reduce insulin by 1-2 units if exercise is very strenuous.
Blood sugar going up and down - No pattern.	Major food and insulin changes. Make earlier clinic appointment. Contact Diabetes Team.
Blood sugar high after meals then zooming down low. Hypos with no pattern or reason.	Try changing the injection site and reduce the insulin. Contact the Diabetes Team.

If you are unsure, please do not hesitate to ask for help.

Sometimes you may need to test after meals in order to determine which insulin mixture would be best for you to balance with your diet. If you have 3 or 4 injections each day, please discuss with your Diabetes Team.

Disclaimer

This website is designed for use by the Leeds Paediatric Diabetes Team and children and parents referred to their service. Every effort has been made to make sure there are no errors on the website. If you think there are any inaccuracies could you please e-mail us so that we can check. kate.barker@leedsth.nhs.uk