Finally, no matter what the glucose level was at breakfast, if the glucose level after breakfast or before lunch was low, then the breakfast nutritional dose should be decreased for the next day. If the glucose level before breakfast was high, and the glucose level at lunch was at goal, then no change in the nutritional dose will be required for the next day. If there was a significant increase in the glucose level from before breakfast to before lunch, then the total dose of insulin the patient received at breakfast (nutritional plus correctional) should be increased and should become the nutritional dose for breakfast the next day. A simple approach is as follows: If there was no significant change in the glucose level from before breakfast to before lunch, then the total dose of insulin the patient received at breakfast (nutritional plus correctional) should be used as the nutritional dose for breakfast the next day. The glucose level at bedtime will indicate whether the insulin given at dinner was appropriate. Continue to repeat 10 units subcut and POC blood sugar checks every 90 minutes until blood glucose is less than 300 mg/dL. For example, the glucose level just before lunch will indicate whether the insulin given at breakfast was appropriate. Administer 12 units subcut, notify provider, and repeat POC blood sugar check in 90 minutes. Nutritional Insulin: The adequacy of the nutritional insulin dose is based on the glucose level prior to the next meal.
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