Dose of Insulin After Hypoglycemia
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Monday, February 13, 2006 |
Q: "I am a diabetic taking one morning dose of Lantus® in the A.M. along with three individual doses of NovoLog® before each meal. I take my blood sugar each morning before giving myself the insulin. My question is: if my blood sugar is low...let's say 60 or below...and I eat some crackers with juice which raises it to above 150, should I go ahead and give myself the morning doses of insulin since my blood sugar is now at an acceptable level, or should I skip them? And why?"
A: First, you need to get this specific advice from your doctor and/or diabetes educator.
The fact that you asked this type of question tells me that you need to learn a little more about insulin and adjusting doses before you can consider changing the dose on your own. While I cannot give medical advice over the internet, I can explain the principles involved. In addition, there are things you didn't clarify that would affect the answer, such as:
- Do you have type 1 or type 2 diabetes? That answer determines somewhat whether or not you have any of your own circulating insulin.
- Do you follow a varying scale of insulin--i.e. do you take correction doses when your glucose is higher than usual?
- Has your doctor or diabetes educator taught you basic principles of adjusting insulin?
- When have you been told to call your doctor? All people with diabetes should be taught specific instructions re: when to call, how to determine if the dose needs adjusted, etc.
- Have you been taught how to treat hypoglycemia and evaluate the cause, as well as to determine when you should report the hypoglycemia?
So, taking all the above into account:
- Evaluate the cause of the hypoglycemia: Generally, the most common cause of the low glucose in the morning would be due to the Lantus (the long-acting insulin), as this is the 24-hour background insulin. On the other hand, it could be due to increased activity the night before, or decreased food. So if the Lantus dose is the cause, your doctor would then advise you to decrease your Lantus dose from hereon after--but that is only if your doctor and you determine your pattern and decide that the Lantus dose is too high. The point here is that it is important first to determine the cause of the hypoglycemia. It would be extremely rare that you would omit your entire Lantus dose, as this is providing you with background insulin for 24-hours, mainly between meals.
- Treat the low glucose first: The usual plan would be to treat the low glucose as you did--i.e. juice, and follow with a snack if the meal were not due within the hour--and then take your usual NovoLog (the rapid-acting insulin) dose of insulin with your meal-- in this case, with your breakfast. This is because if you didn't take your breakfast dose of NovoLog, your glucose will usually rise too high, as you still need the NovoLog to handle your breakfast.
- Opinions and circumstances vary! However, not all doctors agree with this, as some people find that once they're low, they stay low for awhile (especially if their background insulin--the Lantus dose--is too high), so some doctors will have you decrease your NovoLog dose just one time for that meal, due to the recent hypoglycemia.
- Another point of caution: If you have been taught to take varying doses of NovoLog based on your current blood glucose, you might be tempted to take a larger dose after hypoglycemia if, for example, you treated the low glucose and then your blood glucose level 20 minutes later were above 200. However, this rise in your blood glucose level would have been just a temporary rise due to the juice you just ingested, so you would NOT base your insulin decision on that temporarily elevated glucose.
Regardless, you can see that there are many things to consider, and there is no standard answer I can safely give you. This is a question that needs to be specifically addressed by your doctor.
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Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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