Patients' experiences of adjusting insulin doses when implementing flexible intensive insulin therapy: a longitudinal, qualitative investigation.

Aim: To explore patients' experiences of using flexible intensive insulin therapy, a regimen requiring them to determine and adjust quick-acting and background/basal insulin doses and mealtime ratios.

Methods: Repeat, in-depth interviews with 30 type 1 diabetes patients converted to flexible intensive insulin therapy recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK.

Results: While patients found determination of quick acting insulin doses relatively straightforward, many struggled, over time, to determine the correct mealtime ratios and adjust basal insulin doses independently. Reasons included: lack of confidence and poor analytical skills; deferential attitudes to health professionals; worries about hypoglycaemia; and, lack of record/diary keeping resulting in fixation on current readings and failure to spot patterns and problems. When health professional support was not sought and/or record keeping neglected, patients gradually developed over-reliance on corrective doses to attain blood glucose readings within target ranges.

Conclusion: While patients are motivated to use flexible intensive insulin therapy, they expressed a need for on-going health professional input, particularly to support adjustment of background insulin doses and mealtime ratios. The need to sustain diary/record keeping should be emphasised to patients and provision of a dedicated glycaemic support service is recommended.