Chapter Eight: Insulin Dose Changes :: Nationwide Children's Hospital

Insulin Dose Changes

 For children with diabetes, blood glucose levels can go up and down a lot. Often, these changes happen at the same time of day, like at meal times or bedtime. As time goes on, you will be able to find these patterns in blood glucose changes more easily. It is important that you know how to make the right changes to your child’s or your own basal and bolus insulin doses for these patterns. This will help keep blood glucose levels in the right place (target range). The Diabetes Team will work with you and your family to help make the right insulin dose changes.

What You Need

Before you start you will need to have these supplies and information ready.
You will need to:
  • Have a blood glucose log – Record your blood glucose results here. You should be checking blood glucose before all three meals and before going to bed.
  • Know your insulin doses – You will have two different types of insulin doses:
    • Basal insulin – This is the Lantus® insulin that works over a long period of time.
    • Bolus insulin – This is the Novolog® or Humalog® insulin that is based on how many carbohydrates you are eating and how high your blood glucose is.
  • Know your target blood glucose range for your age
    • Birth to 5 years: 100-180 mg/dL
    • 6 to 9 years: 80-140 mg/dL
    • 10 years and older: 70-120 mg/dL

How to Find Blood Glucose Patterns

Many different things can make blood glucose go up or down, like exercise, food, or stress.
 
1. Review the past week’s blood glucose levels in your log. Look at the same times of day tested for each day of the week, like breakfast, lunch, dinner, or bedtime.
2. Look for blood glucose numbers that are above or below your target range.
3. Look for patterns in the blood glucose numbers.
  • Are they below target range? Are they below target at a certain time of day?
  • Are they above target range? Are they above target at a certain time of day?
  • Is there no clear pattern?

4. Look to see if blood glucose levels are out of range after a certain event, like after a high blood glucose correction, bolus, exercise, or birthday parties or special events.

5. Look for other things that may make blood glucose numbers out of range unexpectedly. These may not be good reasons to change an insulin dose.
  • Unplanned activity/exercise
  • Dirty fingers at the time of testing
  • Wrong carbohydrate counting or eating more or less than expected
  • Timing of meals
  • Expired insulin or test strips
  • Meter not working
6. A change in the insulin dose may be needed if:
  • You are using the correction factor often.
  • You are treating low blood glucose often.

When To Change Your Basal Insulin Dose (Lantus®)

If you find a pattern that your blood glucose is above or below target range before breakfast, you may want to change your basal insulin. Changing your basal insulin will help keep your blood glucose in target range during the night.

Step 1: Change your basal insulin dose (Lantus®).

  • For blood glucose that is above target --> Increase your basal dose (see chart below).
  • For blood glucose that is below target --> Decrease your basal dose (see chart below).
Use the chart below to change your basal insulin dose.
 
Current Basal Dose (Lantus®) For Basal Dose Increases For Basal Dose Decreases
1 to 5 units Increase by 1/2 unit Decrease by 1/2 unit
6 to 15 units Increase by 1 unit Decrease by 1 unit
16 to 25 units Increase by 2 units Decrease by 2 units
26 to 35 units Increase by 3 units Decrease by 3 units
36 to 45 units Increase by 4 units Decrease by 4 units
46 units or more Increase by 5 units Decrease by 5 units

Step 2: Check 3 a.m. blood glucoses.

It is important to make sure the basal insulin change is right for you. You will want to check your blood glucose at 3:00 a.m. for 2 to 3 days after you make a change to your Lantus®.
  • If your blood glucose is below target range at 3:00 a.m., then decrease your basal dose.
  • If your blood glucose is above target range at 3:00 a.m., then increase your basal dose.

When To Change Your Bolus Insulin Dose (Humalog®/Novolog®)

If your blood glucose is above or below the target range, you may need to make changes to your bolus insulin dose. Follow the steps below to see how to understand blood glucose patterns and how to change your bolus insulin dose.

Step 1: Check Your Blood Glucose

Check your blood glucose before lunch, dinner, and bedtime.

Step 2: Read the Results

If your blood glucose is above or below your target range before lunch, dinner, or bedtime, you may need to make changes to your bolus insulin dose.
It is important to change bolus insulin doses if blood glucose is:
  • Below target range for 2 days in a row --> Decrease bolus insulin (See Step 3a)
  • Above target range for 3 days in a row --> Increase bolus insulin (See Step 3b)

Step 3a: Decrease Your Bolus Insulin Dose (Humalog®/Novolog®)

You know to decrease the bolus insulin dose if your blood glucose has been below target for 2 days in a row. Now you need to know when and how much to change it. Changing this dose is based on your Insulin to Carb Ratio.
  • First, know your current Insulin to Carb Ratio. Your Insulin to Carb Ratio is _____.
  • Next, use the chart below to know when to decrease your bolus insulin dose.
Results of Blood Glucose Test Decrease Insulin: 
Below target before lunch At breakfast
Below target before dinner At lunch
Below before bedtime At dinner
  • Last, use the scale below to INCREASE your Insulin to Carb Ratio by one level from your current ratio. Increasing your Insulin to Carb Ratio means you will be giving less insulin.
1:5 --> 1:6 -->1:7 -->1:8 -->1:10 -->1:12 -->1:15 -->1:18 -->1:20 -->1:22 -->1:25 -->1:30 -->1:35 -->1:40 -->1:45 -->1:50
 

Step 3b: Increase Your Bolus Insulin Dose (Humalog®/Novolog®).

You know to increase the bolus insulin dose if your blood glucose has been above target for 3 days in a row. Now you need to know when and how much to change it. Changing this dose is based on your Insulin to Carb Ratio.
  • First, know your current Insulin to Carb Ratio. Your Insulin to Carb Ratio is _____.
  • Next, use the chart below to know when to increase your bolus insulin dose.
Results of Blood Glucose Test Increase Insulin: 
Above target before lunch At breakfast
Above target before dinner At lunch
Above before bedtime At dinner
  • Last, use the scale below to DECREASE your Insulin to Carb Ratio by one level from your current ratio. Decreasing your Insulin to Carb Ratio means you will be giving more insulin.
1:50 -->1:45 -->1:40 -->1:35 -->1:30 -->1:25 -->1:22 -->1:20 -->1:18 -->1:15 -->1:12 -->1:10 -->1:8 -->1:7 -->1:6 -->1:5
 

What To Do After an Insulin Change

Continue to monitor blood glucose levels.
  • If glucoses continue to be below target range after 2 days, decrease insulin again.
  • If glucoses continue to be above target range after 3 to 5 days, increase insulin again.

When To Call The Doctor

Always call the doctor if you are not sure about how to change your basal or bolus insulin doses.
  • You can FAX your blood glucose log or pump/meter download to 614-722-3062.
  • You can CALL in your blood glucose log to 614-722-4425.
  • You can SEND in your blood glucose log using your “myChart” account.

Back to the Managing Your Diabetes Resource Book Table of Contents »

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000