How to Start Mealtime (Bolus) Insulin

Add 4 units of mealtime insulin to the basal dose before the largest meal or the meal that is agreed upon.

How to Adjust Your Bolus Insulin

When Mealtime Insulin is Taken: When to Test Blood Sugar: If the Blood Sugar Results Are:
Then You Should:
When:
At Breakfast Before Lunch

Under 80
Subtract 2 Units from Mealtime Dose

80 – 130
Do Not Adjust Mealtime Insulin Dose

Over 130
Add 2 Units to Your Mealtime Dose

Before Breakfast the Next Day
At Lunch Before Dinner

Under 80
Subtract 2 Units from Mealtime Dose

80 – 130
Do Not Adjust Mealtime Insulin Dose

Over 130
Add 2 Units to Mealtime Dose

Before Lunch the Next Day
At Dinner Before Bed

Under 125
Subtract 2 Units from Mealtime Dose

125 – 150
Do Not Adjust Mealtime Insulin Dose

Over 150
Add 2 Units to Mealtime Dose

Before Dinner the Next Day

If blood sugar is under 70, drink 1/2 cup of juice or soda or eat something that contains sugar.
You can also take glucose tablets to bring your blood sugar into normal range. Let your physician/care team know that you had low blood sugar.

These recommendations are derived from expert opinion and are based on the review of the following literature:

i Inzucchi, et al. Management of Hyperglycaemia in Type 2 Diabetes: A Patient-Centered Approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-79

ii Nathan, et al. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy. Diabetes Care. 2006; 8: 1963-1972

iii Davidson, M. Raskin, P. Tanenberg, R. Vlajnic, A. Hollander, P. A Stepwise Approach to Insulin Therapy in Patients with Type 2 Diabetes Mellitus and Basal Insulin Treatment Failure. Endocrine Practice. 2011; 17: 395-403

iv Pearson, J. and Powers, M. Systematically Initiating Insulin: The Staged Diabetes Management Approach. The Diabetes Educator. 2006. 32: 19S-28S.

v Bergenstal, et al. Adjust to Target in Type 2 Diabetes. Diabetes Care. 2008. 31(7) 1305-1310.

vi Hirsch, I. Bergenstal, R. Parkin, C. Wright, E. Buse, J. A Real-World Approach to Insulin Therapy in Primary Care Practice. Clinical Diabetes. 2005. 23(2): 78-86

vii A Step-Wise Approach — Indications and Usage. FlexPen®, NovoLog®, and Levemir®. Novo Nordisk. 2011