# Insulin Dose Adjustment REAL-Time CGMS Guidelines for Subjects on Pump Therapy

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2 Use your ICR ratio for every meal and a correction factor to "correct" for the high and bring it down into range. If you don't use ICR or correction factors, then you will need to instead increase or decrease the bolus (short-acting) insulin doses by small steps (1-2 units). Example: Your ICR = 1 unit for 10 g of carbohydrate Your target blood glucose = 5.5mmol/L Your high glucose correction is 1 unit per 2.75mmol/L over your target. Your current blood glucose is 11.0mmol/L, and you are about to eat 60g of carbohydrate. The sensor Indicates ( ) two up arrows. Calculate: 6 units of insulin (for the 60 g of carbohydrate) + 2 units (for the high glucose correction of 1 unit for each 2.75mmol/L over target) units trend arrow correction (20% of 8 units) for a total of 9.6 units. Infuse 9.6 units. Correction Bolus Calculation at Times Other Than Meals Do your usual calculation of the amount of rapid-acting insulin needed to correct for the high blood sugar. Look at the RT-CGM arrow and make the following adjustments to the amount of rapid-acting insulin that you just calculated to cover the high blood sugar. Glucose rising >2.2mmol/L Increase meal dose by 20% ( ) two up arrows Glucose rising by mmol/L Increase meal dose by 10% ( ) one up arrow Glucose rising or falling by <1.1mmol/L, no arrows No change in meal dose of rapid acting insulin Glucose falling by mmol/L Decrease meal dose by 10% ( ) one down arrow Glucose falling by >2.2mmol/L Decrease meal dose by 20% Example for time other than meal: Using the example above (without the meal), you would correct for a high blood sugar of 11.0mmol/L with ( ) one up arrow. Calculate: 2 units for the high glucose correction (1 unit for each 2.75mmol/L over target) units trend arrow correction (10% of 2 units = 0.2) for a total of 2.2 units. Infuse 2.2 units. 2

4 If there are no patterns, don't make any changes. 4

5 SUGGESTED INSULIN DOSE ADJUSTMENT Glucose pattern (2-3 days) Blood glucose in morning Suggested changes Look at your bedtime blood glucose, and if that is out of range work on correcting that before trying to change the overnight insulin. Increase the basal insulin rate by units/h starting 3 h before your morning sugar check Check blood glucose at 3:00 a.m. If high at that time, increase the basal rate by units/h from midnight to 2 a.m. Consider eating fewer carbs in your bedtime snack or increase bedtime snack ICR (example: if 1:15, change to 1:10) Look at your bedtime blood glucose, and if that is out of range work on correcting that before trying to change the overnight insulin. Decrease basal insulin rate by units/h starting 3 h before your morning sugar check. Check blood glucose at 3:00 a.m. If low at that time, decrease the basal rate by units/h from midnight to 2 a.m. Consider eating more carbs in your bedtime snack or decrease bedtime snack ICR (example: if 1:15, change to 1:20). Consider adding protein or fat to your bedtime snack. 5

6 SUGGESTED INSULIN DOSE ADJUSTMENT Glucose pattern (2-3 days) BG pre-lunch Suggested changes Breakfast ICR: increase ratio by 5g (example: if 1:15, change to 1:10). Cut out or decrease mid-morning snack. Increase basal rate by units/h from 8 to 10 a.m. Breakfast ICR: decrease ratio by 5g (example: if 1:15, change to 1:20). Consider adding or increasing a morning snack. Decrease basal rate by units/h from 8 to 10 a.m. BG pre-dinner Lunch ICR: increase ratio by 5g (example: if 1:15, change to 1:10). Consider cutting down or reducing the afternoon snack. Increase the basal rate by units/h between lunch and 3 p.m. Lunch I/C ratio: decrease ratio by 5g (example: if 1:15, change to 1:20). Consider adding or increasing the afternoon snack. Decrease the basal rate by units/h between lunch and 3 p.m. 6

7 SUGGESTED INSULIN DOSE ADJUSTMENT Glucose pattern (2-3 days) Bedtime Suggested changes Dinner ICR: increase ratio by 5g (example: if 1:15, change to 1:10). Increase the basal rate by units/h between dinner and 8 p.m. Dinner ICR: decrease ratio by 5g (example: if 1:15, change to 1:20). Decrease the basal rate by units/h between dinner and 8 p.m. 7

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