Adjusting the basal or long-acting insulin dose based on fasting glucose levels (on awakening before you consume  food or sugar containing beverages) can be an important aspect of diabetes management for people who use insulin therapy. If your physician approves self-adjustment of your basal insulin dose, follow the steps outlined below.

1. Check your fasting glucose levels for three or four days using your sensor or a glucose level obtained by the fingerstick method.

2. Refer to your target fasting glucose level or range. Your target fasting glucose level will depend on a variety of factors, including your age, overall health, and diabetes history. Your physician will help you determine this target level. 

3. Based on your recent fasting glucose levels and your target, you may need to adjust your insulin dose. If your glucose levels are higher than your target level, you will need to increase your basal insulin dose. If your fasting glucose levels are lower than your target level, you will need to take less basal insulin. The exact changes in your dose will be recommended by your physician and will depend on your current basal insulin dose (which is a reflection on your insulin sensitivity) and possibly also by how high or low your glucose levels are above or below target.

4. If your fasting glucose levels are close to your target level or within target range, do not change the basal insulin dose.

5. Continue to monitor your fasting glucose levels. Increases in the basal insulin dose are typically made at 3 or 4 day intervals, since that much time is required for the insulin to reach a new “steady state” after an adjustment. Do not make daily or frequent increases in your basal insulin dose unless specifically told to do so by your physician, such as during an acute illness or when starting or tapering off medications known as glucocorticoids.

6. Low or hypoglycemic readings are often more concerning than high readings, and if your glucose levels are below target your physician may recommend reductions in your basal insulin doses which are larger than the increases made for high glucose readings. He or she could also recommend more frequent or even daily basal dose reductions.

7. If your glucose levels remain high or low despite adjustments in your insulin dose, contact your healthcare provider for additional guidance. Never hesitate to call our clinic for further advice if you develop severe hyperglycemia (high blood sugar) or symptomatic or frequent hypoglycemia (low blood sugar).

It's important to remember that adjusting insulin based on glucose levels should be done in consultation with your healthcare provider. Be sure to follow all instructions provided by your physician and the insulin manufacturer for safe and effective insulin use.