Analyze This!
Interpreting Your Monitoring Log

• Note that her blood glucose tends to drop between lunch and dinner when she is active. Perhaps she needs less medicine on active days or more carbohydrate at lunch.
• Walking tends to lower her blood glucose level. Without activity, her blood glucose rose after dinner. But with activity it dropped a bit. Perhaps a daily walk after dinner should be part of her routine.

Daniel. A 20-year-old college junior, Daniel takes multiple injections of insulin. He provided the table here. Can you pinpoint the reasons for Daniel’s erratic control? Here are some observations:

• Skipping his morning snack made Daniel’s blood sugar lower by lunchtime, so he shouldn’t forget to eat it. With morning runs, he may need a larger morning snack or less fast-acting insulin.
• Daniel’s blood glucose level tends to rise from lunch to dinner. Perhaps he needs a larger dose of NPH in the morning or fewer grams of carbohydrate in the afternoon. Exams may cause his blood glucose to rise even higher, so perhaps he needs extra insulin on test days.
• Without any activity after dinner, Daniel’s blood glucose tends to be high at bedtime. He might need extra lispro (brand name Humalog) at dinner if no activity is planned.
• Following evening basketball, Daniel’s blood glucose level tends to drop overnight. Perhaps he needs a larger bedtime snack or less NPH insulin after playing basketball.

Renee. Renee, a 9-year-old girl, uses an insulin pump. Renee takes a unit of insulin for every 15 grams of carbohydrate plus a “sliding scale” to correct highs and lows at mealtimes. Insulin sliding scales are prescribed increases or decreases made to your mealtime insulin dose based on your premeal blood glucose level. Your health-care provider may advise you to take a larger insulin dose if your blood glucose is above a certain level or a smaller dose if it is below a certain level. While using a sliding scale may be appropriate in some instances, it is not a substitute for good control. So if you are adjusting your insulin doses more than twice a day, you may need to examine your diabetes logbook to find the source of your erratic blood glucose levels or consider the possibility that changes are needed in your overall insulin regimen.

What could account for Renee’s dramatic blood glucose changes, especially during the night?

• Renee’s blood glucose level is rising during the night, even when she has no bedtime snack. Her basal insulin rate probably needs to be increased from bedtime until morning. (”Basal” insulin is delivered every few minutes in small increments to cover the body’s general need for insulin.)
• Renee’s high readings at lunch-time are probably due to taking too little insulin at breakfast. She may need a unit of insulin for every 10 grams of carbohydrate at breakfast, plus supplemental insulin to cover any high readings. On gym days, she may only need 1 unit for every 15 grams of carbohydrate.
• “Grazing” in the afternoon tends to produce high dinner readings even if the snacks are covered with a bolus of insulin. Perhaps Renee should limit herself to one snack right after school.
• Note that swimming practice and swimming in a meet have very different effects on Renee’s blood glucose. She might need to reduce her dinner insulin to 1 unit per 25 grams of carbohydrate before practice but increase the dose to 1 unit per 10 or 12 grams before meets.