Insulin dose adjustments

Question 1

When should basal insulin (e.g., insulin glargine) be increased?

Answer 1

A: If fasting blood glucose (pre-breakfast) is consistently above target (e.g., >7 mmol/L on 2–3 days in a row), increase the basal dose by 2 units.

Question 2

When should basal insulin be decreased?

Answer 2

A: If fasting blood glucose is consistently below target (e.g., <4 mmol/L) or the patient experiences nocturnal or fasting hypoglycaemia, decrease the basal dose by 2–4 units.

Question 3

When should bolus insulin be increased?

Answer 3

A: If the corresponding post-meal or next pre-meal blood glucose is consistently above target (e.g., >8–10 mmol/L), increase that bolus dose by 1–2 units.

Question 4

When should bolus insulin be decreased?

Answer 4

A: If the patient is having hypoglycaemia (BG <4 mmol/L) at the corresponding time, reduce that bolus dose by 1–2 units.

Question 5

What factors may require temporary insulin dose reduction?

Answer 5

A: Illness, reduced food intake, increased activity, alcohol intake, or renal impairment.

Question 6

Q: What is the ‘3-day rule’ in insulin dose adjustment?

Answer 6

A: Only adjust insulin doses if readings are consistently high or low for at least 3 days in a row at the same time of day.