Glucose Targets: How to Adjust your Insulin Doses

Your Diabetes Targets:

• Pre meal Blood Glucose Levels (BGL): 4 mmol/L – 7 mmol/L
• Continuous Glucose Monitor (CGM) Time In Range (TIR) of at least 70%
• HbA1c less than 6.5% 
  

High blood glucose = Hyperglycaemia

BGL Above 7 mmol/L before meals +/- 10 mmol/L or higher 2-3 hours after eating 

Low blood glucose =Hypoglycaemia

BGL of 3.9 mmol/L or less

Look for patterns 

If you notice a high or low blood glucose pattern for 3 days in a row or 4 times in 1 week this means that your child's insulin doses or ratios need to be adjusted

Key tips to making the right dose adjustment: 

Do not change your insulin based on a single higher or lower reading 

Make another change after 3 days if needed

If you are using CGM login to your account to look at your data on a computer or tablet 1-2 times per week to view glucose patterns (LibreView®, Clarity®, Glooko®, CareLink®). These reports allow you to view your Time In Range and see the times of the day you are running higher/lower and need to make a change. 

Check glucose levels 2 hours after eating. If your glucose is between 3.9 – 10 mmol/L the insulin dose is appropriate

 How to adjust insulin 

Tips to keep in mind when considering making an increase to insulin doses:

• Check for previous hypoglycaemia and adjust long-acting insulin working overnight to manage low glucose levels first 
• Sometimes glucose levels can go higher after treating a low glucose reading. If there is a pattern of glucose levels going above 7 mmol/L after treating hypoglycaemia, you should consider if you are over treating the low glucose e.g. by having too much quick acting/high glycaemic index carbohydrate, check hypoglycaemia quantities here
• Consider the timing of your insulin to when you eat your food and wait 15 minutes after giving insulin to help avoid unnecessary glucose spikes after eating
• Make a note of different events on that may have contributed to high glucose levels, such as big family dinners where the dose of insulin was not increased, or sick days where no changes were made to the insulin dose

Tips to keep in mind when considering making a decrease to insulin doses:

• For newly diagnosed patients, changes may be needed more frequently in the initial weeks after being diagnosed because of the “honeymoon” period starting.
• In the weeks after being diagnosed with type 1 diabetes, your body can temporarily make its own insulin again. If you start experiencing low BGLs the doses of insulin will need to be reduced (remember insulin can never be stopped but can be reduced if you are having low glucose readings)
  
• Consider and make note of different days that may have contributed to the hypoglycaemia e.g. a sports day, unwell
• Always ensure you are doing confirmatory finger prick BGL if your CGM alerts for hypoglycaemia