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If you need to speak to one of the Diabetes Nurses about your
diabetes, the address and telephone number are shown below.
Diabetes Centre
Kinsgate House, Wellington Road North,
Stockport, SK4 1LW
Diabetes Specialist Nurses
Jennefer Richmond, Andrea Urwin, Jane O’Brien,
Sheena Cottam, Julie Whitehead
Telephone: 0161 426 5408/5409
Doctor Practice Nurse
Name
Telephone No:
Reviewed 2004
This booklet aims to give you some general guidelines on how to adjust
morning CLOUDY
CLEAR insulin by
your insulin doses safely. There maybe a number of reasons why your
insulin by 4 units.
insulin by 4 units.
CLOUDY insulin
morning CLEAR
15 mmols/litre
blood glucose is unusually high or low on an occasion and these are listed
evening meal
evening meal
below: -
INCREASE evening INCREASE
INCREASE
INCREASE
INCREASE evening INCREASE
by 4 units.
or Higher
4 units.
Possible reasons why your blood glucose is high:
You have forgotten to take your insulin injection.
You have taken a smaller insulin dose than usual.
morning CLOUDY
8 – 14 mmols/litre
You have eaten a larger amount than usual.
insulin by 2 units.
insulin by 2 units.
insulin by 2 units.
insulin by 2 units.
morning CLEAR
meal CLOUDY
Stress/anxiety.
meal CLEAR
Illness.
INCREASE
INCREASE
Insulin Dosage Adjustments – Free Mixing Insulins
Possible reasons why your blood glucose is low:
You have taken a larger insulin dose by mistake.
mmols/litre
You have forgotten a meal.
CONTROL
CONTROL
CONTROL
CONTROL
You may have left a long gap between your insulin injection
GOOD
GOOD
GOOD
GOOD
and meal (particularly if you take Humalog or NovoRapid
4–7
insulin).
You have only eaten a small amount of carbohydrate food.
Very hot or cold weather.
insulin by 2 units.
CLOUDY insulin
CLOUDY insulin
morning CLEAR
CLEAR insulin
Physical exercise.
Blood Glucose
mmols/litre or
evening meal
evening meal
Less Than 4
Alcohol.
by 2 units.
by 2 units.
by 2 units.
REDUCE
REDUCE
REDUCE
REDUCE
morning
Hypo
If your blood glucose level is consistently too high or too low at a
particular time of day on at least two occasions then you should consider
adjusting your dose of insulin. If after reading this booklet you would
Supper/bedtime
Before Evening
like further advice on adjusting your insulin doses please feel free to
Blood Glucose
Blood Testing
Before Lunch
contact the Diabetes Specialist Nurses at Lime House, Stepping Hill
Hospital. Our telephone number and address are on the back page of this
Breakfast
leaflet.
Before
Before
Levels
Times
Meal
Before Evening Meal Injection Listed below are some ‘golden rules’ to guide you in adjusting your
Cloudy insulin - Isophane insulin doses.
Main action between bedtime and breakfast which is reflected in blood test Increasing the dose of insulin will lower your blood glucose level.
results before breakfast the following morning.
If your blood glucose is high (8 mmols/l or more) before breakfast Insulin = Blood
on at least two occasions, INCREASE your cloudy insulin before your Glucose
evening meal.
Reducing the dose of insulin will increase your blood glucose level.
If your blood glucose is low (less than 4 mmols/l) before breakfast
on at least two occasions, REDUCE your cloudy insulin before your
evening meal. However, if you have a severe hypoglycaemic reaction Insulin = Blood
reduce this insulin dose the following day. Glucose
If your blood glucose has been 8 mmols/l or higher for at least two
If you are at all unsure about adjusting your insulin doses, please do days, refer to the insulin dose adjustment chart at the back of this
not hesitate to contact the Diabetes Nurses. leaflet.
Wait at least two days before altering an insulin dose to ensure this
adjustment is necessary.
ONCE is an INCIDENCE TWICE is a COINCIDENCE
THREE TIMES is a PATTERN
If your blood glucose level is very high or very low at a particular time
of day, it is the insulin injection you gave before this reading that you
need to alter. For example:
Your breakfast time insulin affects your blood sugar levels
before lunch and before tea.
Your teatime insulin affects your blood sugar levels before bed
and before breakfast.
If your blood glucose level is very high or very low do not be tempted
to alter the insulin dose you are about to give.
Aim to keep your blood glucose levels between 4 and 7 mmols before
meals.
FREE – MIXING INSULIN REGIMEN
If your blood glucose is low (less than 4 mmols/l) before lunch on at
Clear insulins (fast and rapid acting) least 2 occasions, REDUCE your clear insulin before breakfast.
Humalog (Lispro) However, if you have a severe hypoglycaemic reaction reduce this
NovoRapid (Aspart) insulin dose the following day.
Human Actrapid
Humulin Soluble Before Breakfast Injection
Human Velosulin Cloudy insulin - Isophane
Pork Actrapid Main action between lunch and evening meal which is reflected in blood
Hypurin Porcine Neutral test results before the evening meal.
Hypurin Bovine Neutral
Insuman Rapid If your blood glucose is high (8mmols/l or more) before your
evening meal on at least 2 occasions, INCREASE your cloudy insulin
Cloudy insulins (Isophane - intermediate acting) before breakfast.
Human Insulatard
Pork Insulatard If your blood glucose is low (less than 4 mmols/l) before your
Humulin Isophane evening meal on at least 2 occasions, REDUCE your cloudy insulin
Hypurin Porcine Isophane before breakfast. However, if you have a severe hypoglycaemic
Hypurin Bovine Isophane reaction reduce this insulin dose the following day.
Insuman Basal
Before Evening Meal Injection
This insulin regimen involves mixing two different insulins together and Clear insulin - Soluble, fast or rapid acting
giving them in one injection. It gives the flexibility of being able to Main action between evening meal and bedtime which is reflected in
adjust either a clear insulin or a cloudy insulin according to blood glucose blood test results before bed.
readings at particular times of the day.
If your blood glucose is high (8mmols/l or more) before bed on at
If you are mixing a rapid acting insulin with a cloudy insulin, you should least 2 occasions, INCREASE your clear insulin before your evening
inject immediately before the meal. If you leave a gap between an meal.
injection of rapid acting insulin and your meal, you may risk going hypo.
If your blood glucose is low (less than 4 mmols/l) before bed on at
Before Breakfast Injection least 2 occasions, REDUCE your clear insulin before your evening
Clear insulin - Soluble, fast or rapid acting meal. However, if you have a severe hypoglycaemic reaction reduce
Main action between breakfast and lunch that is reflected in blood test this insulin dose the following day.
results before lunch.
If your blood glucose is high (8mmols/l or more) before lunch on at
least 2 occasions, INCREASE your clear insulin before breakfast.
