Your guide to smooth sailing on insulin devices
Whether you’re newly diagnosed, new to pumping, new to continuous glucose monitoring (CGM), new to Automated Insulin Delivery (AID), or have years of experience, we all need some help and guidance now and then. The daily challenges in managing your glucose sometimes feel like sailing a tiny boat on rough seas. You recognize how vital it is for you to keep your A1c low, your time in range (TIR) high, and your glucose stable, but as unseen winds, waves, and currents toss your vessel about, you might feel like throwing up your hands in frustration. It’s not as though you’re not trying, right? It’s tempting to give up when you feel like you have no control over the often-baffling situations that arise.
This insulin dose guide enhances your understanding of diabetes and insulin delivery devices so you can better manage the daily challenges of diabetes. Insulin requirements and treatment protocols can differ significantly from one person to the next. Although packed with helpful information, this dosing guide can never replace the sound medical advice of your physician and health care team. Their professional advice and support come from knowing you personally and having experience with many other pump and AID wearers.
Selective use of this material can get you in trouble. The authors and this website assume no responsibility for errors or omissions, nor for the uses made of the materials contained herein and the decisions based on such use. No warranties are made, expressed, or implied with regard to the contents of this work or its applicability to specific individuals. The authors and publishers shall not be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of or inability to use these materials.
This comprehensive guide to insulin dosing includes over a dozen pages. Whether you have diabetes or care for those who, please be sure to visit them all. 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 –an all-day steady release of insulin
- Bolus – a quick release of insulin – Carb boluses 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
- 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 overlap and drop your glucose too low
- IOB or BOB – active bolus 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, or an AID system. It helps you 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 or AID for more accurate insulin doses and improved 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. Your goal is to keep your glucose in a relatively normal range with few lows.
More complex 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. 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. Detailed information on current hybrid closed loops and AID systems can be found at our Comparison of AID Systems. The dose guide can certainly be used without a CGM if you do frequent meter testing to measure glucose levels and use a helpful recording system, like Smart Charts or the Enhanced Analysis Weekly Logbook.
See also Record Keeping
Before You Begin to Use the Insulin Dose Guide
To minimize variables, make dose adjustments when your routine is as normal as possible. Keep to your usual levels of activity and exercise, and eat foods that have a known impact on your glucose, especially ones that don’t spike it.
Don’t learn to sail during a storm!
Variables that affect glucose include food, exercise, sleep habits, stress, seasonal changes, weather, hormones, weight gain or loss, and so on. Don’t you love diabetes? Some circumstances may cause abnormal glucose values, such as a friend’s wedding or a cortisone shot for a frozen shoulder. Let unusual situations pass before you get back to checking.
To safely steer your ship, always talk with your clinician before and while making changes as you diagnose problems, test pump settings, and make needed changes. Health care providers have your best interest in mind, but time is limited at appointments. To quickly get to critical issues at clinic visits, write down any problems and questions you have ahead of time, and always bring your CGM record or meter with you. After you or your clinician make adjustments, bring your results to your next appointment. First, let’s eliminate unneeded variables.
BEFORE YOU BEGIN, Eliminate These Unneeded Variables:
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.
Your Steps to Better Glucose Readings:
- Size up your current situation and select your destination. – Review these glucose goals recommended by diabetes organizations, select appropriate personal glucose goals, and monitor your glucose variability.
- Adjust your Total Daily Dose (TDD) of Insulin First – if you have frequent lows or reading that are often high.
- For frequent lows:
- If your glucose goes below 60 mg/dL (3.3 mmol) 4 or more times a week at different times of the day, go to TDD Too High or Frequent Lows (link to: Pattern #3).
- If your lows usually occur at a particular time of day, go to Frequent Lows at a Certain Time of Day(link to: Pattern #4).
- If lows frequently occur within 5 hours after treating high glucose readings, go to Lows from Over-Correcting Highs(link to Pattern #5).
- If your average glucose is over 180 mg/dL (10.0 mmol) or a recent A1c was above 8.0%, and your diet is reasonable, go to TDD Too Low to see how to increase insulin doses and select more appropriate pump settings.
- For frequent lows:
- Check for 11 Common Problem Glucose Patterns and Solutions if your average glucose is less than 180 mg (A1c below 8.0%) without frequent lows, but you still encounter unwanted waves in your control.