Adjusting Your Insulin

Tight blood glucose control is essential to good diabetes management. The two basic tools for this goal are checking and recording blood glucose levels, and then adjusting insulin accordingly. These adjustments require knowledge and some expertise. Before beginning, consult a health care provider.

The First Step: Knowing the Numbers

Studies have shown that people who keep their blood glucose levels as close to normal as possible have fewer complications. Most people measure their blood glucose with a portable device called a glucose meter, or glucometer. This measurement is often called a "finger stick" because the blood sample is commonly drawn from the fleshy part of the fingertip. The most important part of this process is writing down the readings in the patient’s logbook.

Logbooks and Patterns

Self-monitoring also reveals patterns in the fluctuations of blood glucose that can help people with diabetes manage their condition. Talk to a health care provider about how often to test. Based on how much insulin a patient takes, as well as their diet and exercise routine, a health care provider is likely to prescribe a range of times, including:

• First thing in the morning (called fasting glucose)
• Before meals or medications
• After meals (if not regularly, occasionally)
• During exercise
• Before going to sleep
• While experiencing symptoms of low or high blood sugar

In addition to the date and time, patients might want to record what they have eaten, how much insulin has been taken, whether they are feeling stressed or sick, and if they have exercised or eaten more or less than normal. Doing this will show how behavior affects blood sugar. It will also help identify the best strategies for controlling blood sugar levels.

How often patients should test depends on their routine and the recommendations of their health care provider. If control of one’s blood sugar levels is not optimal, a doctor will probably suggest more frequent testing to identify and address problems.

Adjusting Insulin

Adjusting insulin is crucial, and being guided by a health care provider is the smartest way to do this; patients should not try it alone. Aiming to safely adjust insulin is very important. Consistently achieving perfection is impossible. However, trial and error under a doctor’s supervision can teach patients a great deal about recognizing patterns, learning which foods to eat and knowing how much insulin to take for various meals.

Patients who use insulin typically follow either a conventional or intensive diabetes management regimen. Conventional therapy is simplest, but may be considered more limiting. This sort of diabetes management involves taking insulin less than three times per day, and often in fixed doses. In other words, the insulin dose doesn’t change depending on food or exercise.

In contrast, people who are intensively managed take three or more injections a day, or use an insulin pump. Their doses are usually adjusted depending on how much food they are eating, the type of food, or how much they are exercising.

This takes more practice, but allows for greater flexibility in food choice and exercise regimen. The freedom and flexibility are appealing, and although adjusting insulin safely requires effort and knowledge, anyone can learn to do it. Speak with a health care professional to see if this kind of therapy is appropriate.

_Sources:

"Diabetes: New Technologies Make Management Easier." Brigham and Women's Hospital. Aug. 2003. Brigham and Women's Hospital. 9 Sep. 2007. <http://healthgate.partners.org/browsing/browseContent.asp?fileName=42385.xml&title=Diabetes:%20New%20Technologies%20Make%20Management%20Easier&gt;.

Briggs, Amber L, Susan Cornell. "Self-monitoring Blood Glucose (SMBG): Now and the Future." Sage Journals Online Vol. 17, No. 12004 29-38. 09 Feb. 2007. <http://jpp.sagepub.com/cgi/content/abstract/17/1/29>.