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Diabetes pro-tip: Adjusting insulin based on trend arrows on CGMs

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For parents of children with type 1 diabetes, figuring out the right dose of insulin for your child at any given meal, or between meals, can be a challenge. We encourage you to read Adam Brown’s well outlined summary of why this can be so challenging, available on diatribe.org (pdf).

Since the advent of modern continuous glucose monitors (CGM), children with diabetes have one more tool at their disposal to aid them in this decision making. Everyone who wears a CGM becomes rapidly familiar with how to read their sensor glucose reading with their mobile device or smart phone. But what about the trend arrow that accompanies that glucose reading? Familiarizing oneself with what each arrow means can be another piece of the decision-making puzzle for a CGM wearer who is trying to decide how much insulin to take at a meal.

The glucose trend arrow is a valuable tool that provides real-time information about how your child's blood glucose levels are changing in the moment. The arrow points in different directions, indicating the following trends:

  • Horizontal (→): Blood glucose levels are stable.

  • Diagonal up (↗) or down (↘): Blood glucose levels are rising or falling at a moderate rate.

  • Vertical up (↑) or down (↓): Blood glucose levels are rising or falling rapidly.

The calculation for how much glucose to take at any given meal usually involves some number of units based on what your child is going to eat (based on their insulin to carb ratio) and a correction factor if their glucose is above their target. Trend arrows are a separate adjustment beyond simple correction factors.

How to incorporate trend arrows into the calculation

Horizontal (→): If your child's glucose level is stable, and the arrow is horizontal, no adjustments to the insulin dose are needed. One should proceed with their usual dosing routine.

Diagonal up (↗) or down (↘): In case of a diagonal arrow, consider a small adjustment to the insulin dose. If the arrow is pointing up diagonally, you may want to give a small additional dose of rapid-acting insulin above and beyond whatever you are giving to cover the carbs and the glucose reading itself. If the arrow is pointing down diagonally you might want to decrease the insulin dose at meal times.

Vertical up (↑) or down (↓): A vertical arrow requires more significant adjustments. If the arrow is pointing up, administer a larger dose of rapid-acting insulin. If the arrow is pointing down, reduce the insulin dose more significantly at mealtimes.

How much to adjust a pre-meal dose of insulin based on each arrow

This varies for each child and is a great question for your child’s care team at their next visit. This table, available in  English (pdf)and Spanish (pdf) provides a great guide on how to get started with trend arrow-based adjustments based on your child’s individual sensitivity, or correction, factor.

Insulin dosing decisions for people with diabetes can be complex. Our care team is here to assist you with understanding all these factors and we look forward to working with you to help you feel more comfortable with these decisions.