Woman, 42 years of age. Type 1 diabetes for the past 22 years. I’ve been working with her and reviewing her CGM reports, and teaching about checking patterns before making changes in her pump settings.
The other day she sent me her readings for the past two weeks. She told me she sees highs during the night and about 6 pm.
Wondered about changing her settings. I asked her to tell me what she thought she should do. Not to do it yet, but let me know so we can then agree or disagree and decide on the actual adjustments together. This would be the best way for her to learn.
When I looked at the report, I did not see what I know to be a “pattern” or in other words, nothing consistent, for 3 days in a row that would warrant a change. I was actually surprised that she had a high or low here or there about the same time, but thought “inconsistent” warranted a change.
We did not make any changes at that time. I was very clear in letting her know what a pattern actually means (see below). I haven’t heard back from her. That tells me she hasn’t seen a real pattern since we talked.
Disaster averted by preventing hypoglycemia, especially nocturnal, by increasing insulin when not warranted.
When teaching patients, be more specific.
When the word “pattern” is used, teach the patient the difference between correcting and pattern management.
Be very clear to speak in words such as these:
Insulin Dose Changes: Changing your insulin dose may seem difficult and confusing. Health care professionals may ask you to make two different kinds of changes: Correction doses and pattern changes.
If your blood glucose before lunch is almost always normal, but today it is high, you may take 1 or 2 extra units of insulin to “correct” the high reading. This is called a correction dose. This is a temporary change in your dose. If your blood glucose tomorrow before lunch is normal you will not need a correction dose. In contrast, if your blood glucose results before lunch are high for more than 3 days in a row, you will need to make a pattern change. This is a permanent change in your insulin dose. Once you have made a pattern change, you continue to take this dose of insulin until you see that it is no longer keeping your blood glucose “in target” and you then make another pattern change.
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