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Table 2 Previous insulin dose adjustments based on trend arrows recommendations

From: Using trend arrows in continuous glucose monitoring systems for insulin adjustment in clinical practice: Brazilian Diabetes Society Position Statement

Arrow JDRF[4] Scheiner [6] Pettus/Edelman [5] Klonoff/Kerr [10] Aleppo [7] Laffel [9]
Abbott Dexcom Medtronic
Pre-meal 2–4 h Post meal
SF Change Glucose Change SF Change
  ↑↑ ↑↑↑ + 20% + 50 mg/dL + 100 mg/dL + 2 U < 25 + 4.5 U    < 25 + 4.0 U
25–< 50 + 3.5 U    25–  50 + 3.0 U
50–< 75 + 2.5 U > 250 mg/dL Correction acording to SF; check ketones 50– < 75 + 2.0 U
≥ 75 + 1.5 U 75– < 125 + 1.0 U
   ≥ 125 + 0.5 U
↑↑ + 20% + 25 mg/dL + 75 mg/dL +1,5 U < 25 + 3.5 U < 25 + 3.0 U
25– < 50 + 2.5 U 150–250 mg/dL Observe, consider correction according to SF 25– < 50 + 2.0 U
50– < 75 + 1.5 U 50– < 75 + 1.0 U
≥75 +1.0 U 75– < 125 + 0.5 U
   ≥ 125 + 0 U
+ 10% + 0 + 50 mg/dL + 1 U < 25 + 2.5 U No adjustments < 25 + 2.0 U
25–< 50 + 1.5 U 25– < 50 + 1.0 U
50–< 75 + 1.0 U 50– < 75 + 0.5 U
≥ 75 + 0.5 U 75– < 125 + 0 U
   ≥ 125 +0 U
  + 0 + 0 + 0 + 0 No adjustments No adjustments No adjustments
− 10% − 0 − 50 mg/dL − 1 U < 25 − 2.5 U Glucose Change < 25 − 2.0 U
25– < 50 − 1.5 U Near 100 mg/dL Consider 15gCHO
Test 20 min
25– < 50 − 1.0 U
50– > 75 − 1.0 U 50- < 75 − 0.5 U
≥ 75 − 0.5 U Near 150 mg/dL Test 30 min 75- < 125 − 0 U
   ≥125 − 0 U
↓↓ − 20% −  25 mg/dL − 75 mg/dL − 1.5 U < 25 − 3.5 U Near 100 mg/dL Consider 15gCHO
Test 20 min
<25 − 3.0 U
25– < 50 − 2.5 U 25– < 50 − 2.0 U
50– < 75 − 1.5 U Near 150 mg/dL Test 15 min 50– < 75 − 1.0 U
≥ 75 − 1.0 U 75– < 125 − 0.5 U
   ≥125 − 0 U
  ↓↓ ↓↓↓ − 20% −  50 mg/dL − 100 mg/dL − 2 U < 25 − 4;5 U Near 100 mg/dL 30 g fast-acting carbohydrate <25 − 4.0 U
25– < 50 − 3.5 U 25- < 50 − 3.0 U
50– < 75 − 2.5 U 50- < 75 − 2.0 U
≥75 − 1.0 U 75- < 125 -− 1.0 U
          Near 150 mg/dL Test 15 min ≥125 − 0.5 U
  1. The algorithm suggested by Kudva et al. [8] is similar to the one suggested by Aleppo et al. [7], except that the range 150–250 mg/dL for post-meal adjustments (for upward arrows) should be replaced by 180-250 mg/dL. For other glucose values no adjustments are suggested by Aleppo or Kudva [7, 8]. The recommendations suggested by Laffel et al. [9] and JDRF [4] were elaborated for children and adolescents