Problem solving in type 1 diabetes for primary care nurses part 1

How can I adjust insulin dose to improve glucose control?

Consider the individual with type 1 diabetes (T1DM) on a basal-bolus insulin regime. The dose of basal insulin will significantly determine fasting (pre-breakfast) blood glucose (BG) levels, whilst breakfast, lunch and evening meal doses of rapid-acting (prandial) insulin will have an important effect on pre-lunch, pre-evening meal and pre-bedtime BG readings respectively. Table 1 outlines management of BG readings that are higher or lower than desired. Target BG readings are those suggested by NICE but should be individualised, not least with respect to risk of hypoglycaemia and degree of hypoglycaemic awareness.¹