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What are Pattern Management Principles - Part 3

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Find the pattern in Example 1. Blood glucose goal is 4 – 7 mmol/L before meals; before baseline meal insulin is 8 - 8 – 10 units.


Date

Before Breakfast Before
Lunch
Before
Dinner

Before Bed

0300

         Insulin
  Basal         Meal

9.8 7.0 8.7 14.5
NPH 24u.
@10P
9-8-10

10.5 6.2 5.9 12.2

9-8-10

12.6 6.5 6.9 15.6

10-8-10

7.3 5.5 7.5 7.9

8-8-12

6.9






What do you think?   Before dinner and before breakfast are out of target.

Use the Pattern Management guidelines to help you.

  • there are no lows to eliminate
  • overnight control can be improved! But the before bed need improvement too! If the before bed blood sugar improves, then my before breakfast will likely improve (adjust one insulin at a time)


What would you recommend in this situation? Increase my dinner dose by 2 units.

Find the pattern in Example 2. Blood glucose goal is 5 – 7 mmol/L before meals; baseline rapid insulin before meals is 9- 6 - 10 units.



Date

Before Breakfast Before
Lunch
Before
Dinner

Before Bed

0300

         Insulin
   Basal         Meal

6.8 10.4 12.7 7.1
NPH 14 u.
@10P
9-7-12

6.2 14.2 15.9 6.8
NPH 6 u.
@1200
9-8-13

4.6 13.5 13.0 7.8

9-8-12

5.2 9.6



9-


What do you think?

  • No lows to correct
  • Overnight control is good
  • The before lunch and dinner are out of target
      • Increase the rapid acting insulin at breakfast by 1 or 2 units
      • Make one insulin dose change at a time
      • If my before lunch blood sugar is in target then likely my before dinner blood sugar will be in target