Achieving Tight Control
Here is some general advice on how to improve your control on an intensified regime using Glargine (Lantus) or Isophane insulin (Humulin I, Insulatard or
NPH)as the basal insulin and either Soluble (Humulin I, Actrapid or
Regular insulin), Humalog or Novorapid insulin with meals. However many
specialists in diabetes are now recommending Glargine and Humalog or Novorapid insulin to ease tight control with less hypoglycemia and weight gain
There are 4 important variables to consider and integrate.
1. The insulin dose, both mealtime and basal insulin,
2. The carbohydrate content of the meal or snack,
3. The pre and post meal physical activity,
4. Your general physical state or well being, e.g. if you have an infection or in women the phase of the menstrual cycle.
You are aiming for:
A fasting (as you wake) blood glucose between 5-7 mmols.
2-hour post-meal blood glucose between 6-8 mmols.
First Fix-The Fasting Glucose
The most important time of the day is to make sure that your fasting pre-breakfast blood glucose is between 5-7 mmols.
This is a good indicator that your blood sugar will have been well
controlled overnight. Reducing fasting glucose by 2 mmols will reduce
HbA1c by about 1%. The limiting factor is always nighttime hypoglycaemia
If you find that your blood sugar is not in this range,a suggested plan to adjust treatment follows:-
Blood Glucose less than 5 mmols or hypos during night
- Reduce Glargine (or Isophane) at night by 2 units
Blood glucose 5-7 mmols
- No adjustment required
Blood glucose 7-9 mmols
- Increase Glargine (or Isophane) by 2 units
Blood glucose 9-11 mmols
- Increase Glargine (or Isophane) by 4 units
Blood glucose greater than 11 mmols
- Increase Glargine (or Isophane) by 6 units,
Then wait 3 days before you make further adjustments, as it takes some time for Glargine to re-balance.
Post Meal Glucose Levels
2 hour post meal glucose should be in the range 7-9 mmol. If they are not, a suggested plan to get them back to target is:-
- Reduce Soluble/Humalog/Novorapid at same mealtime next day by 2 units
Blood glucose 6-9 mmols
- No adjustment required
Blood glucose 9-11 mmols
-Increase Soluble/Humalog/Novorapid at same mealtime next day by 2 units
Above 11 mmols
- Increase Soluble/Humalog/Novorapid at same mealtime next day by 3 units