Self‐adjustment of insulin: An educational failure?

Self‐adjustment of insulin doses by diabetic patients is widely encouraged but efficacy of technique has not been evaluated or audited.

We recently published a series of guidelines for insulin adjustment in the BDA lay journal, “Balance” and a quiz for readers to complete and submit.

Six questions gave home blood glucose (BG) profiles on various insulin regimens. Patients were asked what adjustments to dose, if any, were required.

Sixty insulin‐treated diabetics responded, 97% were actively adjusting their doses. Only five (8%) answered all six questions correctly; 73% reacted wrongly to a single‐day BG profile; 22% made potentially hazardous changes in response to obviously erratic profiles; 63% changed doses of a once‐daily insulin system despite clear advice to the contrary. When specific insulin changes were indicated, 25% responded with the wrong insulin for a twice‐daily short/intermediate insulin system and 37% for a “Novopen” system.

We conclude that even amongst interested and motivated patients knowledge of self‐adjustment principles is poor. These skills need to be specifically taught to selected patients and their response requires auditing. If such a programme cannot be provided, then self‐adjustment should not be encouraged.