Adjusting the basal dose

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At what point do you adjust your child's basal insulin? The following adjustments are best done in consultation with your child's doctor. However, if you're unable to see the doctor, you can put your knowledge to use and make the adjustments on your own.

1 Bedtime basal insulin: If you find that several mornings in a row your child's fasting blood glucose is too high (above the levels in Table 10-3), you may add a unit or two to his bedtime basal insulin. If it's too low, you may reduce his bedtime basal insulin by a unit or two or get him to eat a small bedtime snack.

1 Morning basal insulin: A high blood glucose level throughout the day is an indication to raise the morning basal insulin by 1 or 2 units. Getting hypoglycemia at different times of day is a reason to lower the morning basal by 1 or 2 units.

Several weeks after starting insulin, you may find that you can lower your child's dose (of both bolus and basal insulin) more and more and even go off it for as long as six months. This is the honeymoon phase. It's a period of remission when the insulin in his pancreas is controlling the glucose. He may need little or no insulin for this period, but there usually comes a time when he has to start insulin again. It's extremely important to measure your child's glucose frequently so you know when to reestablish the insulin.

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