Too many lows? Too many highs? Readings all over the place? Feel like a tiny boat on rough seas? Don’t know what to do? Whether you’re newly diagnosed, on multiple daily injections (MDI), new to pumping, new to continuous glucose monitoring (CGM), new to Automated Insulin Delivery (AID), or have years of experience on insulin, we all need some help and guidance now and then. You recognize how vital it is to keep your A1c low, your time in range (TIR) high, and your glucose stable. It’s tempting to give up when you feel like you have no control over the often-baffling situations that arise. But there’s hope.
Our insulin dose guide will shed much-needed light on these situations. The guide helps you start simple, interpret glucose graphs, charts, and real-time CGM displays, and turn them into improved actions, settings, and outcomes.* It also teaches you step-by-step how to improve your settings in a pump, give more accurate insulin doses, and arrive at better glucose readings. You learn to navigate to smoother waters with the long-term rewards of good health and longer life, plus short-term benefits of feeling better now, with more energy to work, play, and be the person you want to be.
Comment, questions, and suggestions are welcome at the bottom of each page.
- AGP – Ambulatory Glucose Profile
- AID – Automated Insulin Delivery or hybrid closed loop
- Basal/LAI –an all-day steady release of insulin from a pump or a long-acting insulin
- Bolus/SAI – a quick release of insulin from a pump or injection of short-acting insulin – Carb boluses/injections cover carbs and correction boluses lower high readings
- Bolus Calculator (BC) – calculates bolus recommendations
- CarbF or Insulin to Carb Ratio (CarbF, ICR) – the number of grams of carbohydrate covered by 1 unit of insulin
- CGM – continuous glucose monitor
- Correction Target – the BG a correction bolus aims for
- Correction Factor or Insulin Sensitivity Factor (CorrF, ISF) – how many mg/dl or mmol one’s glucose is reduced by 1 unit
- CV – coefficient of variation, aka glucose variability
- Duration of Insulin Action (DIA) or Active Insulin Time (AIT) – how long a bolus (5-6 hrs for current insulins) lowers the BG – used as a pump set to calculate residual IOB activity
- Insulin Stacking – occurs when the action of two or more boluses or SAI doses overlap and drop your glucose too low
- IOB or BOB – active bolus or SAI insulin on board that is still lowering the glucose from recent boluses
- MDI – multiple daily injections
- TIR – time in range, the percentage of time your glucose stays between 70 to 180 mg/dL (3.9 to 10 mmol)
- TDD – total daily dose – an average of all basal and bolus doses of insulin (or long and short-acting doses) taken per day
But there’s hope!
This insulin dose guide provides more confidence in the use of an insulin pump and CGM, an AID, or a bolus calculator (BC), and MDI with the goal is to keep your glucose in a relatively normal range with few lows. Although this guide is often used with a CGM, it can also be used if you do frequent meter testing to monitor glucose levels and use a BC or a helpful record system, like Smart Charts or the Enhanced Analysis Weekly Logbook. See also Record Keeping.
To minimize variables, make dose adjustments when your routine is as regular as possible. Keep to your normal levels of activity and exercise, and eat foods that have a known impact on your glucose, especially ones that don’t spike it.
Detailed information on current hybrid closed loops, and AID systems can be found at our Comparison of AID Systems. AID systems simplify management through a combination of an insulin pump, a CGM, a software control algorithm, and sometimes a dedicated PDA or smartphone app for remote operation. They are also beginning to appear for smart pen users. The algorithm or “brain” of the system oversees insulin doses that attempt to regulate glucose levels amidst the daily impact of meals, exercise, stress, medications, hormone levels, and other factors.
First, Eliminate Unneeded Variables on a Pump (or BC):
- Use a no-fail infusion set to eliminate unexplained high glucoses (UHGs).
- Verify your pump and bolus calculator (BC) settings – they’re often wrong!
- Check the DIA/AIT time on your pump or BC – set this between 5 and 6 hours to avoid bolus insulin stacking.
- Verify the glucose target on your pump or BC.
Follow the steps below if you consume a relatively healthy diet. For those on a low carb or keto diet, go directly to Step 3 for Pattern Management.
This Guide Includes the Following Sections:
- Size up your situation and select your goal. – Review these glucose goals recommended by diabetes organizations, choose your own glucose goals, and learn how to check your glucose variability.
- Adjust your Total Daily Dose (TDD) of Insulin – if you have frequent lows or highs.
- For frequent lows:
- If your glucose goes below 70 mg/dL (3.9 mmol) 4 or more times a week at different times of the day, go to Lower Your TDD or Frequent Lows.
- If your lows usually occur at a particular time of day, go to Frequent Lows at a Certain Time of Day.
- If lows frequently occur within 5 hours after treating a high glucose reading, go to Lows from Over-Correcting Highs.
- If your average glucose is over 165 mg/dL (9.2 mmol) or a recent A1c was above 7.4%, and your diet is reasonable, go to Raise Your TDD to learn how to increase insulin doses and select more appropriate pump settings with the Pump/BC Settings Tool.
- For frequent lows:
- Check for these Common Unwanted Glucose Patterns if you do not have frequent lows, highs, or unwanted swings in your readings. These target specific areas for improving your readings.
Check each step above for guidance on how to improve and stabilize your readings.
Congratulations, you’ve finished learning how to adjust your insulin doses on MDI, pump, CGM, BC, or AID! Revisit this exercise any time your glucose readings start to stray. When life changes, so do insulin doses.