Other less obvious factors that affect the bodys use of insulin must also be taken into account. For example, some people may find that their bodies process insulin better on hot days so require less insulin. With this, the person again has to adjust their dose to the best of their understanding from their past experiences. The DAFNE regime requires the person to learn about their bodys needs through experience, which takes time and patience, but it can then become effective. Closed-loop predictive modeling
People with fluctuating insulin requirements may benefit from a closed-loop predictive modeling approach. As an extension on "carb counting", in this closed-loop predictive modeling approach, the four daily insulin dosages needed to reach the target blood sugar levels for the "normal" daily carbohydrate consumption and amount of physical activity, are continuously adjusted based on the pre-meal and pre-night blood sugar level readings. Each new blood sugar reading provides the feedback to fine-tune and track the bodys insulin requirements. Within this strategy, the key specific factors, which have to be determined experimentally, are the blood sugar correction factor and the carbohydrate ratio. The blood sugar correction factor sets both the "proportional gain" and "integral gain" factors for the four feedback loops. When taken too low, deviations from the target blood sugar level are not corrected for effectively, when taken too high, the blood sugar regulation will become unstable.
Regular insulin, lispro, aspart and glulisine can be used for this purpose. Regular insulin should be given with about a 30-minute lead-time prior to the meal to be maximally effective and to minimize the possibility of hypoglycemia. Lispro, aspart and glulisine are approved for dosage with the first bite of the meal, and may even be effective if given after completing the meal. The short-acting insulin is also used to correct hyperglycemia.The usual schedule for checking fingerstick blood glucose and administering insulin is before all meals and sometimes also at bedtime. More recent guidelines also call for a check 2 hours after a meal to ensure the meal has been covered effectively. Sliding scales
First described in 1934, what physicians typically refer to as sliding-scale insulin (SSI) is fast- or rapid-acting insulin only, given subcutaneously, typically at meal times and sometimes bedtime, but only when blood glucose is above a threshold (e.g. 10 mmol/L, 180 mg/dL). The so-called "sliding-scale" method is widely taught, although it has been heavily criticized. Sliding scale insulin (SSI) is not an effective way of managing long-term diabetes in individuals residing in nursing homes. Sliding scale insulin leads to greater discomfort and increased nursing time. Sample regimen using insulin glargine and insulin lispro:

Insulin glargine: 20 units at bedtime

Carb counting and DAFNE
A more complicated method that allows greater freedom with meal times and snacks is "carb counting." This approach is taught to people who are diabetic in the UK and elsewhere as "Dose Adjustment For Normal Eating" or DAFNE.