This site is intended for healthcare professionals only

Problem solving in type 1 diabetes for primary care nurses part 1

Written by: | Published:

Diabetes test Type 1 diabetes is less common than type 2 and provides its own discrete problems

How can I adjust insulin dose to improve glucose control?

Consider the individual with type 1 diabetes (T1DM) on a basal-bolus insulin regime. The dose of basal insulin will significantly determine fasting (pre-breakfast) blood glucose (BG) levels, whilst breakfast, lunch and evening meal doses of rapid-acting (prandial) insulin will have an important effect on pre-lunch, pre-evening meal and pre-bedtime BG readings respectively. Table 1 outlines management of BG readings that are higher or lower than desired. Target BG readings are those suggested by NICE but should be individualised, not least with respect to risk of hypoglycaemia and degree of hypoglycaemic awareness.1

For the person with T1DM taking a twice daily mixed (biphasic) insulin (combined intermediate-acting plus rapid-acting insulins) similar targets and dose adjustments apply. The morning dose of mixed insulin will determine pre-lunch and pre-evening meal BG readings whilst the evening dose will determine pre-bedtime and fasting BG levels. The regime is inherently less flexible than the basal-bolus regime and in the requirement to avoid hypoglycaemia less tight glycaemic control may have to be accepted.


Please login or register to read the rest of the article and to have access to downloads and comments.

What do you think? Leave a comment below or tweet your views to @IndyNurseMag

This material is protected by MA Healthcare Ltd copyright.
See Terms and Conditions.

Read a free issue from Practice Nursing

Register to read a free issue from our sister publication, Practice Nursing.

Including articles on asthma, diabetes and more. Read your copy.


Sign up to the newsletter


Independent Nurse is the professional resource for primary care and community nurses, providing clinical articles for practice nurses and prescribers.


Subscribe to our newsletter and stay up to date with the latest nursing news.

Stay Connected

Stay social with Independent Nurse by following us on Twitter, liking us on Facebook or connecting on LinkedIn.


Need access to some of our older articles? You can view our archive, or alternatively contact us.

Contact Us

MA Healthcare Ltd.
St Jude's Church, Dulwich Road
London, SE24 0PB

Tel: +44 (0)20 7738 5454
Registered in England and Wales No. 01878373

Meet the team


Find out how to contribute to Independent Nurse here.