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Tips on Adjusting Insulin

June 29, 2022
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Earlier this year, we published an article about Looking for Glucose Patterns about how to identify patterns in your glucose levels. The follow-up is what to do when you find certain patterns, whether it’s adjusting insulin doses, changing the timing of insulin dosing, or reaching out to your healthcare team because you need guidance; we hope to help you feel more confident and comfortable in navigating pattern management.

As you become more experienced in your diabetes journey, you should find it easier to self-manage. If you’re earlier in your diagnosis or have not gotten any instruction on how to adjust insulin doses, you probably want to consult your endocrinologist or healthcare team before making any changes. For me, when I was pregnant, I got A LOT of personal practice making adjustments because I did not want to wait one to two weeks to make changes since there were more risks to waiting.

General Recommendations

There are some general guidelines that are published on different hospital websites including Nationwide Children’s in the U.S., Torbay and South Devon from the U.K., but there are not standards in the American Diabetes Association’s Standards of Care. Both have similar recommendations with regards to adjusting insulin doses.

  1. First identifying that there is a true pattern, which could be defined as having a consistent pattern of lows for 2 to 3 days in a row, or a pattern of highs for 3 days in a row.
  2. It’s important to make one change at a time and give it some time to see if it works.
  3. Small, incremental changes are usually the safest way to go.
    1. Such as an increase or decrease of 10%, or even 5% if you or your child are very insulin sensitive.
    2. On the other hand, if you or your child are very insulin resistant, you may need to make a more aggressive change, maybe closer to 20%.
  4. When you make changes to Insulin to Carb Ratios or Insulin Sensitivity, the larger the number is, the less aggressive it is.
    1. For example, when you are having highs after meals and need more insulin for meals, if your insulin to carb ratio is 1:20, to make a change that will give you more insulin, you will lower the number to 1:18 for a ten percent change.

Important Considerations

It is worth discussing this with your healthcare team so they can help guide you through the learning process of adjusting insulin based on glucose patterns. When making changes, check your/your child’s glucose more often or pay closer attention to your or your child’s continuous glucose monitor (CGM) because there may be more fluctuations than normal.

It’s also important to keep in mind that different temporary changes in glucose levels may be normal, such as related to a menstrual cycle, illness, stress, or periods of growth for children and adolescents. Also, if any changes that you make are causing extreme highs or lows, you should consult with your medical team and consider putting the settings back how they were before you made the changes.

Closed Loop Systems and Smart Algorithms

Now that hybrid closed loop systems are available to help improve glycemic control for people with diabetes, hopefully there will be less need to make insulin adjustments. There are some algorithms in development, such as the iLet, that will be adaptive, meaning they will change when peoples’ insulin needs change.

There are also tools that use algorithms to help healthcare providers make standardized changes, such as Endo Digital Advisor Pro. And, of course, there are smartphone apps available to help with glucose management decisions such as SugarIQ and Bolus Calculators, and data integration systems such as Glooko, One Drop and mySugr.1 All of these tools are designed to help people increase their Time in Range (TIR) and reduce the burden that diabetes can cause.

Until There’s a Cure, There’s Friends for Life

There is so much to look forward to in the future of diabetes management and not having to think about how to adjust insulin doses to increase time in range is a very exciting prospect. Until this is available, hopefully these tips about adjusting insulin will help from the perspective of increasing TIR. And, as for the burden that diabetes tends to be, there will always be Friends for Life to help provide education and support.

Hope to see you there next week!

    1. PATIENT RESOURCES: Diabetes Technology

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES