What are Pattern Management Principles - Part 3
Answers
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.
Date Before Bed 0300
Before Breakfast
Before
LunchBefore
Dinner
Insulin
Basal Meal
6.8
10.4
12.7
7.1
NPH 14 u.
@10P9-7-12
6.2
14.2
15.9
6.8
NPH 6 u.
@12009-8-13
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
