What are Pattern Management Principles - Part 1

We use Pattern Management to establish the correct baseline doses.

Consistency in food (carbohydrates in particular) and activity are essential to finding the right insulin dose.

Changes to the baseline dose are indicated when there are consistent patterns in glucose levels over 2-3 days. We evaluate the effect of each dose of insulin by looking at the glucose level before and after each dose.

Analyzing blood glucose results is called Pattern Management. It is a way to look at the effect of each insulin dose, food choice and/or activity on blood glucose levels. Blood glucose testing is the only way to know the effect of each meal, activity or insulin dose.

What are patterns?

Patterns are trends in blood glucose levels. Look for the blood glucose response in at least 3 similar situations, at the same time period. If the blood glucose level follows the same trend 2 out of 3 times, this is called ‘pattern’. Do not expect to see exactly the same levels, just the same trend.

How to begin?

• Know your blood glucose goals

        Before meals:   _________________ mmol/L
        2 hours after eating:   _________________ mmol/L

• Look for patterns over 2 to 3 days. Keep your food and activity consistent for these 3 days. Write down testing results, insulin dose and food amounts helps to identify patterns more easily. Or you can use a computer program to track the information.
• Look for WHEN your blood glucose is outside the goal range.
  
• First, look for lows. Getting rid of lows will prevent highs after.
  

• Then look at blood glucose levels overnight. Check the blood glucose at bedtime and in the morning before breakfast (and maybe during the night too, about 3-4:00 AM). The goal is to find the insulin dose that keeps the blood glucose level stable from bedtime to morning without causing a low.

• Look for details! You are always testing how well the last insulin dose worked.

• If your blood glucose results are not in the goal range, consider possible reasons for this. Ask yourself:

• Would it be suitable to make changes to your food or activity?
• WHICH insulin dose or meal has the most effect on your blood glucose at this time?

How to get back into target

• Decide if the insulin or the food needs to be increased or lowered? If you are happy with the amount of food you are eating, then change the insulin dose.
• When patterns are seen over 2 or more days and you have ruled out any other cause, you should change the baseline insulin dose. Change one insulin at a time. Adjust by one or two (1-2) units, or 10% of the dose of insulin at a time.
• Always check the effect of adjusting your food or insulin. Check your blood glucose more frequently for at least two days in a row after you have changed your plan.
• Remember, Pattern Management should be done on an ongoing periodic basis. Things change!