TR is 25 and has new type 1 diabetes and is hoping to get on an insulin pump soon. TR weighs 70 kgs and takes 8 units basal insulin at bedtime, plus takes 1 unit bolus insulin for every 15 gms of carbohydrate and their correction for hyperglycemia is 1 unit for every 50 points above 120. When looking at TR’s ambulatory glucose profile, their time in range is 32% with 67% above range and about ~1% below range. Glucose levels tend to increase starting with dinner at 5pm and stay elevated throughout the night.
Based on this information, what change(s) could help improve time in range?
- Avoid Somogyi effect from stacking bolus insulin.
- Change insulin to carb ratio to 1:17.
- Increase basal insulin by 2-3 units.
- Adjust correction ratio to 1 unit for every 60 points above 120.
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