MDI therapy is used for the treatment of type 1 diabetes, where your body does not produce enough insulin, or a chronic type 2 diabetes, if your body’s ability to produce insulin has deteriorated to a point where you have an insulin deficiency. In MDI therapy, you take long-acting basal insulin once or twice a day and the rapid-acting insulin before meals.
In the basic monitoring of MDI therapy, the recommendation is to check your blood sugar in the mornings and before meals, at bedtime and otherwise when required. In reality, you will check it 5–10 times per day. As glucose sensing has become more common, there is less need for checking your blood sugar.
The evening-to-morning paired tests reveal whether the basal insulin, which acts during the night, is suitable. Depending on the product, the basal insulin regimen is adjusted once or twice a week. Some people administer the basal insulin in the morning and evening. In this case, a blood sugar test before dinner and supper shows the effect of the basal insulin taken in the morning, provided that the previous mealtime or correction insulin dose was taken 3–4 hours ago.
In addition to the evening and morning tests, you may need to check your blood sugar approximately 4 hours before you wake up. For instance, if your blood sugar is normally high in the morning, there may be several reasons for it:
Your blood sugar increases in the small hours
Your blood sugar is already high when you go to bed
Your blood sugar drops at night, resulting in reactive hyperglycaemia, i.e. a rebound high blood glucose level in response to low blood sugar, in the morning
The pre-meal/post-meal tests, meaning a reading before and approximately 2 hours after a meal, are done at the start of the treatment and when necessary later on to determine the appropriate insulin-to-carbohydrate ratio.
Test always when needed and before driving
Your blood sugar may drop too low as a result of insulin. In addition to basic monitoring, you should always perform the blood sugar test if your blood sugar feels too low. You should also check your blood sugar before operating a motor vehicle. You may also need to perform additional tests when you are doing physical exercise or in specific situations, for example, on sick days.