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The insulin sensitivity factor.
Modification of basal insulins.
The insulin sensitivity factor (FSI)
In the chapter related to capillary glycemia and control objectives55 it shows how compensating supplements are made to correct the glycemia that are out of targets.However, on some occasions, these indications do not give the desired result.Therefore, there are more accurate formulas to adjust the preprandial insulin doses, according to our previous glycemia.
The insulin sensitivity factor indicates the amount of glucose (mg/dl) that decreases 1 fast/ultra -granted insulin unit.
If we are injected ultra -grape insulin, the 1800 rule is used that is calculated by dividing 1800 between the total insulin dose in 24 hours.(1800 between the total insulin dose in 24h.)
Example: A person treated with ultra-grape insulin: 6-8-4-8U.and ultrastont: 20u.It has a total of 46 units.The 1800 rule consists of dividing 1800/46 = 40 mg/dl.This means that 1 ultra -granted insulin unit decreases glucose 40 mg/dl.
So, if the desired glycemia is less than 130 mg/dl and my glycemia is 210 mg/dl.I will have to inject 2 units more than the basic insulin base pattern to correct hyperglycemia and approach the preprandial objectives.
If, instead of ultra -grape insulin we were using rapid insulin, the 1500 rule would be used. The calculation formula is the same as in the previous example but divides 1500 between the total insulin dose in 24 hours.
However, if glycemia are repeatedly out of objectives and not occasionally, it is convenient that you know how to modify the basal doses.
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55 Chapter 3: Capillary glycemia and control objectives.
Modification of basal insulins
How to act in the face of repeated or low or low glycems?
Correcting the glycemia that are occasionally out of targets is important56, but it is more important to correct the tendency to repeatedly present glycemia out of objectives.To do this, it is essential that you know how to inject the insulin well and measure the blood glucose correctly.
To correct repeated or low glycemia, the base pattern must be changed.We call the insulin base pattern that the doctor has recommended to manage when blood glucose is within objectives.
The glycemia objectives must be progressive and adapted to each person and must be agreed between doctor and patient assessing benefits and risks.
Initially, it is necessary to consult with your medical team or nurse educator to tell you how to modify the pattern and why.Later, you can do it yourself without too much difficulty.
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56 See compensating supplements in Chapter 3: Capillary glycemia and control objectives.
General rules for adjusting insulin base pattern
• Never change the dose before checking that alteration is not due to diet changes, exercise or other factors.Other factors influence diabetes in addition to insulin.
• Before a change of the base pattern, a trend should be verified;An isolated determination is not enough.
• Never change the dose in more than one of the injections per day, except disasters.
• Start the adjustment trying to adapt fasting blood glucose;Then you will adjust the remaining ones.
• All changes must be small, prudent, but frequent.
The IDF57 guide recommends adjusting the dose every 3 days, 2 in 2 units until the goal is achieved.
It is veryImportant knowing how to adjust insulin doses.
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57 IDF: International Diabetes Federation.
When my glycemia, in general, are out of the range, in what order should the doses change?
1st Adjust the slow/ultralcent insulin analog.
2nd Adjust the fast/ ultra -grape insulin dose before breakfast.
3º Adjust the rapid/ ultra -grape insulin dose before the food (or the fast or the insulin mixture 50% or 70%, if you use it).
4th Adjust the fast/ ultra -grape insulin dose before the snack.
5th Adjust the fast / ultra -grape insulin dose before dinner.
Glycemia too high before breakfast with ultralight insulin at night
The glycemia of before breakfast is too high and is injected at night of slow/ultra -eating insulin (Levemir® or Lantus®):
• It is very important to start the morning well.To do this, we will have to have previously adjusted glycemia when bedtime.If your glycemia when bedtime is greater than 200 mg/dl, do not expect to get up with less than 130 mg/dl.
• Once the glycemia of the Reena is adjusted, we will begin to correct the glycemia of breakfast.
• If for 3 days the glycemia of before breakfast is greater than 130 mg/dl, increase 2 units the analogous of slow/ultralent insulin that usually injected you at night.If all glycemia were greater than 180 mg/dl, increase the analogous of the slow/ultra -night insulin of the night in 4 units.
• If 3 days after making the change we have not achieved the objective, we will increase the night dose of slow/ultralent insulin analogue.
• If we have inexplicable glycems before breakfast (less than 100 and over 180 mg/dl) we will check the glycemia when we go to bed and correct them looking for glycemia between 100 and 140 mg/dl.If inexplicable glycems persist before breakfast, we will verify that the glycemia between 03:00 and 04:00 in the morning are not less than 65 mg/dl.
Adequate glycemia before breakfast but high before food
• If for 3 days the glycemia of before the food is greater than 130 mg/dl, the rapid/ultra-switch of breakfast analogue analogue must increase 1-2 units.
• If glycemiah less than 80 mg/dl 2 hours after breakfast appear, you have to increase CH rations at breakfast.
• If, despite this, hyperglycemia persists before food, an intake could be made in mid -morning, putting the fast/ultra -grape -grape analog units that correspond by ration.
• But, if you do not want to make a second breakfast, another option would be to put an ultrastical insulin dose at breakfast - always supervised by its endocrine.
Adequate glycemia before food but high before dinner
• If for 3 days the glycemia before dinner is greater than 130 mg /dl, 1-2 units must be increased the analogous of rapid /ultra-grape insulin in food.
• If glycemiah less than 80 mg/dl appear 2 hours after the food, choles of cho in food must be increased.
• Yes, despite this, hyperglycemia persists before dinner, an intake could be made in the middle of the afternoon, putting the fast/ultra -grape -grape analog units that correspond by ration.
• But, if you do not want to make a second snack, another option would be to put a fast or insulin mixture 50% or 70% in the food - always supervised by its endocrine.
Glycemia too high after meals
• If for 3 days the blood glucose of 2 hours after breakfast is greater than 180 mg/dl, the rapid/ultra-granted insulin analogous analogous of before breakfast must be increased 1-2 units.
• If for 3 days the blood glucose of 2 hours after theFood is greater than 180 mg/dl, the rapid/ultra-grape insulin analogue of before the food must be increased 1-2 units.
• If for 3 days the blood glucose of 2 hours after dinner is greater than 180 mg/dl, the rapid/ultra-granted insulin analogous analogue of before dinner must be increased.
Low glycemia before breakfast
• If 1 only day the glycemia from before breakfast is less than 70 mg/dl but the glycemia of the Reena was adequate (100-140 mg/dl), the analogous of slow/ultra-ultralent insulin of the night decreases 2 units.
• If 1 only day the glycemia from before breakfast is less than 50 mg/dl but the glycemia of the Reena was adequate (100-140 mg/dl), decreases 4 units the analogous of slow/ultra-ultralent insulin of the night.
• However, if the glycemia in the right were less than 100 mg/dl, it must be corrected before decreasing the analogous of slow/ultra -night insulin at night.
Low glycemia before breakfast
• If for 3 days the glycemia of before the food is low but the glycemia after breakfast is within objectives (80-180 mg/dl), reduce 1-2 units the analogous of the rapid/ultra-grape insulin from before thebreakfast.
• But, if in doing so, glycemia after breakfast exceeds 180 mg/dl, continue with the previous treatment and add a ration of CH in the middle of the morning.
Adequate glycemia before the food but drops before dinner
• If for 3 days the blood glucose is low before dinner but the glycemia after the meal is within objectives (80-180 mg/dl) Reduce 1-2 units the fast/ultra-sword insulin analog.
• But, if doing so, the glycemia after the food exceeds 180 mg/dl continues with the previous treatment and add a ration of CH in the middle of the afternoon.
Recommendations to observe before any insulin adjustment by altered glycemias
• These changes should be made if altered glycemies are not a consequence of changes in diet, exercise, etc.
• It is a priority to solve hypoglycemia, if there were, before increasing the dose of basal insulin.
• Prudent but frequent changes are safer and give better results.A prudent change is made every 3 days and modifying no more than 3-4 units each time.
• Do not change all basal insulins at the same time.
If you have doubts, call your doctor or educator, without waiting for the next consultation.
Remember: if you have doubts, fears, you don't know how to solve some problems or you are simply demotivated;Contact your health team.
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