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Bolus/Basal Dose Evaluation

How do I evaluate my bolus/basal doses for each meal period to determine if they are correct? Use Pattern Management again!

The only way to properly evaluate you baseline basal meal dose(s) is to do frequent testing, or to use the Continuous Glucose Monitoring System (CGMS).

When doing this evaluation, you must keep your carbohydrate intake for each meal period as well as your activity level consistent for a period of at least 2-3 days. We recommend focusing on one meal period at a time.

Keep detailed records of glucose values, carbohydrate intake, insulin doses and activity level (use a  logbook).

Your goal should be to have good 2-hour post-meal sugar levels without episodes of low or high sugars levels between meals.

There are 2 different situations for evaluating your basal/bolus insulin doses:


When not omitting a meal

Follow these steps to evaluate each meal period/insulin dose:
       
        Breakfast:
For 2 - 3 days in a row have breakfast using usual doses.

        • test sugars (BG) before and 2 hours after breakfast
        • test every 1 to 2 hours until 1:00 pm with no snacks in between.


        Lunch: For 2-3 days in a row have lunch using your usual doses.

        • test BG before and 2 hours after lunch
        • then test every 1 to 2 hours until dinner time with no snacks in between


        Dinner: For 2-3 days in a row have dinner using your usual doses.

        • test BG before and 2 hours after dinner
        • test every 1 to 2 hours until midnight with no snacks in between


        Overnight:
Have usual bedtime snack (if normally taken) for 3 days in a row.

        • test BG at bedtime (before and 2 hours after the snack)
        • test at 3:00, 5:00, 7:00 and 9:00 a.m. for 3 days in a row

        What do I do with the information?

        • if your blood glucose levels are above your target 2 hour post-meal, increase your bolus dose for the meal. Decrease your bolus dose if your levels are below target 2 hours post-meal.
        • if sugars are in target 2 hours after the meal but higher than target before the next meal, increase your basal rate.
        • if sugars are in target 2 hours after the meal but lower than target before the next meal, decrease your basal rate.
        • contact your doctor or diabetes nurse for assistance.


When omitting a meal

Follow the steps below to evaluate each meal period/insulin dose:

        Breakfast: For 2-3 days in a row:

        • test fasting BG before and don’t eat breakfast
        • then test every 1 to 2 hours until 1:00 p.m. with no food/snacks in between


        Lunch: For 2-3 days in a row:

        • test BG before lunch and don’t eat lunch
        • then test every 1 to 2 hours until dinner time with no food/snacks in between


        Dinner: For 2-3 days in a row:

        • test BG before dinner and don’t eat dinner
        • then test every 1 to 2 hours until midnight with no snacks in between

        Overnight: For 2-3 days in a row:

        • test BG at bedtime and don’t eat a snack
        • test at 3:00, 5:00, 7:00 and 9:00 a.m.


        What do I do with the information?

        • your basal rate should not vary by more than 1.7mmol/L
        • you will need to adjust your basal rate if sugars increase or decrease by more than 1.7mmol/L
        • contact your diabetes team for assistance

           

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