Insulin Facts and Adjustment Guidelines HF#4676

 

Monitoring Blood Sugar (glucose)

 

Discuss with your diabetes team about what times to check your blood sugar. You should also discuss your blood sugar (glucose) goals or target range.  Your target range may change based on the time of day, type of insulin you use, and your activity.

 

Timing	TargetRange	Test (yes/no)	Comments
Before Meals
After Meals
Bedtime
During the Night
Exercise

 

 

 

 

 

 

 

 

Your current A1C is: ______%.           Estimated Average Glucose (eAG) _____

Your target A1C value is:   _____ %.   Estimated Average Glucose (eAG) _____

 

 

My Insulin Doses

 

Basal Insulin is: ___________	Meal Insulin (Bolus) is: ___________
Time: _____ Units: _______	1st meal: ______________ units
Time: _____ Units: _______	2nd meal: ______________ units
	3rd meal: ______________ units
	Snacks: _______________units

 

 

 

 

 

l____________________l___________________l___________________l

1st meal                  2nd meal                      3rd meal                    1st meal

 

 

 

Key Points about Your Insulin

 

This chart lists all of the available types of insulin.  Onset means how long insulin takes to start working.  Peak means when it works the best.  Duration means how long it affects your glucose.  Insulin does not work the same in all people.  Times may vary.

 

Insulin Name	Onset	Peak	Duration	Key Points
Rapid-acting (bolus)
Humalog® (lispro) Novolog® (aspart) Apidra® (glulisine)	5-15 min	1-2 hours	3-4 hours	Insulin is clear. Take within 10 minutes before or after eating. Keeps glucose stable 2-3 hours after eating.
Short-acting (bolus)
Regular	30-60 min	2-4 hours	6-10 hours	Insulin is clear. Take within 30 minutes of eating. Keeps glucose stable 2-3 hours after eating.
Intermediate-acting (basal)
NPH (N)	1-2 hours	4-8 hours	10-20 hours	Insulin is cloudy. Always roll the bottle to mix the insulin before using each time. Keeps glucose stable between meals and overnight. This insulin can be mixed with another insulin in the same syringe.
Levemir® (detemir)	1-2 hours	6-8 hours	12-24 hours	Insulin is clear. Keeps glucose stable between meals and overnight. This insulin can be mixed with another insulin in the same syringe.
Long acting  (basal)
Lantus® (glargine)	1-2 hours	Flat	24+ hours	Insulin is clear. Take at the same time(s) every day. Never mix with another insulin in the same syringe. Keeps glucose levels stable between meals and over night.
Combinations (bolus and basal insulin)
Novolin 70/30 Humulin 70/30	30  min	varies	12 hours	Insulin may be clear or cloudy. Ask if you have questions about this. These combinations include basal and bolus insulin. Do not adjust doses of these insulins without talking to your health care team. These insulins are not ideal for patients with Type 1 diabetes.
Novolog® 70/30	10-20 min	1- 4 hours	15-18 hours
Humalog® 75/25, 50/50	5-15 min	Varies	15-18 hours

Expiration Dates

 

Type of Insulin	Refrigerated or not, once opened, insulin expires in:
Insulin Vials Detemir (Levemir®)   All other types of insulin	42 days 28 days
Pre-filled Insulin Pens  (*do not refrigerate pens in use) 70/30, 50/50, 75/25 (cloudy) NPH  (cloudy) Glargine, Regular, Humalog®, Apidra®, Novolog® (clear)	10 days 14 days 28 days
Insulin Cartridges (*do not refrigerate pens in use) 70/30, 50/50, 75/25 (cloudy) NPH (cloudy) Regular, Novolog®, and Humalog® (clear)	7 days 7 days 28 days

 

 

Correction Insulin

 

Before meals, if blood glucose is:	Take extra insulin as noted below:

Correction insulin is meant to “correct” a high blood sugar before eating.  It is given in addition to the dose you take to cover your meal.

• It will not prevent high blood sugar.
• Not all insulins are used to correct high blood sugars.  Only Humalog^®, Novolog^®, Apidra^® and Regular are used.
• Eat your usual amount of food. Eating less will put you at risk for low blood sugars.
• If you need to use correction insulin for three (3) or more days in a row, call your diabetes team.  Your scheduled meal dose may need to be changed.
• Please refer to the section below for key points of adjusting insulin.
• Correction insulin is not to be taken at bedtime unless your diabetes team has given you a bedtime scale.

 

Your correction insulin is: _______________________

 

Take 1 unit of insulin per ______ mg/dL if blood glucose is more than ______.

 

 

Key Points of Insulin Adjustment

• Identify patterns first.
• Eliminate low blood glucose (hypoglycemia) second.
• Decrease the number of high blood glucose (hyperglycemia)

 

Rules

• Test blood glucose before each meal, 2 hours after meals and at bedtime.  Ask whether any other testing times would be helpful.
• Keep a consistent pattern for activities and meals while adjusting your insulin.
• Write down your blood glucose readings.  Take note of how much insulin you took each time.  This helps when learning how to adjust your doses.
• Change only one type of insulin at a time.
• Change the dose every 3-4 days.  Changing the insulin dose too often will not help to get the right dose.
• Change the dose by 1 to 3 units at a time.  Changing by larger amounts can cause low blood sugars.

 

The grid below will help you decide which insulin to adjust based on the time of day and the type of insulin.

 

If your blood glucose is not at target at this time:	Adjust this dose of Insulin:
Breakfast
2 hours after breakfast
Lunch
2 hours after lunch
Evening meal (dinner or supper)
2 hours after a meal
Bedtime
During the night

 

Effects and Precautions with Activity

 

• Activity may lower your blood sugar.
• The effect of exercise on your blood sugar can last as long as 24 hours.
• Ask your diabetes team if your insulin needs to be adjusted to prevent low blood sugars before you start to exercise.
• Ask if you should change how you eat or snack to prevent low blood sugars.
• When blood sugars are over 250-300mg/dL, exercise can cause the blood sugar to go higher.  Do not exercise if your blood sugar is over 300 mg/dL.

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 12/30/2009

Copyright © 12/30/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4676

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