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. For example, the glucose level just before lunch will indicate whether the insulin given at breakfast was appropriate. Nutritional Insulin: The adequacy of the nutritional insulin dose is based on the glucose level prior to the next meal.
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