Basal Bolus Insulin Regimen

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Why Basal-bolus Insulin Therapy May Be The Best Choice For Type 2 Diabetes

Many medications, both oral and injectable, exist to manage blood glucose in type 2 diabetes. Even insulin has many different formulations, including fast-acting and long-acting analogs as well as various pre-mixed combinations of faster and slower acting insulins in the same vial. This large selection of treatments is necessary because type 2 diabetes generally progresses over time from insulin resistance to outright beta cell failure. As a result, treatments must frequently be changed or added to one another in order to maintain good control. As the disease progresses, insulin might be combined with one or more oral agents, or different types of insulin might be used together to control glucose. Basal-bolus insulin therapy is one method of using different insulins together to treat diabetes. In order to understand basal-bolus insulin therapy, it is important to understand how the body uses the insulin it produces naturally. Insulin released from the pancreas helps move glucose from the bloodstream into the cells of the body, which then use the sugar for energy. Because the cells need energy all the time, the body must have not only a constant supply of glucose, but also enough in Continue reading >>

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  1. Stump86

    Basal/Bolus Therapy

    Basal/Bolus Therapy
    (Multiple Daily Injections (MDI) & Pumping)
    What is Basal/Bolus Therapy?:
    Basal/Bolus Therapy is the attempt by insulin users to mimic a healthy pancreas by delivering insulin constantly as a basal and as needed as a bolus.
    A basal is insulin administered constantly to keep the blood glucose (BG) from fluctuating due to the normal release of glucose from the liver. The liver releases glucose and fats constantly to keep you alive in between meals. Without a constant release of insulin, BG would increase over time, so a basal insulin is given to combat this.
    On MDI a basal insulin is used, which is a long lasting insulin. The two newest are Lantus and Levemir, favored for their long duration (near 24 hours in most people) and flat profiles. They are taken usually once or twice a day and act to mimic basal insulin secretion of a healthy pancreas. As a result, a basal insulin is said to be at the correct dosage when it acts only to counter the constant release of glucose into the bloodstream.
    Basal testing is the method by which insulin users test their basal to ensure it is acting as it should. By skipping activities that would alter their BG (eating, exercise, bolus insulin) users are able to monitor BG fluctuations based on basal insulin action only and determine whether or not their basal insulin is properly set.
    Bolus insulin mimics the burst secretions of the pancreas in response to increases in blood glucose. Bolus insulin is often broken up into meal and correction boluses.
    Meal Boluses are boluses given to reduce BG upon the intake of carbs. Carbs are digested into simple sugars which pass readily into the bloodstream. A healthy pancreas is capable of detecting minute changes in BG and releasing insulin based on the amount of glucose in the blood. Insulin users must determine their meal bolus based on the amount of carbs they eat in a practice known as carb counting which is often tempered by the amount of fats and proteins eaten as well. Insulin is then taken in hopes of matching what a normal pancreas would secrete under the same circumstance and in an attempt of normalizing BG, usually within a few hours.
    Correction Boluses are any boluses taken to bring BG back to normal from a higher number. There are many reasons why a correction bolus would be given, but the purpose is always to return to normal numbers. A healthy pancreas is sensitive enough to change its insulin secretion on a constant basis, and non-diabetics do not typically experience highs. So correction boluses are unique to insulin users.
    Pump Use
    Pump users also practice basal/bolus therapy, through the use of an insulin pump which even more closely mimics a pancreas as it is capable of administering insulin in very small amounts and at a constant rate. Pump users are also capable of changing their basal insulin at will, something which MDI users cannot do, and often have an easier time responding to glycemic excursions than MDI users do.
    Because each insulin has a specific purpose, basal bolus therapy is very dynamic, allowing practitioners to eat a variety of foods and still experience good BG control. Basal/Bolus Therapy is often more difficult than other insulin regimens because occasional basal testing and carb counting are vital to success, and exercise can be tricky to deal with, but it is by far the most flexible method currently available.

  2. Lloyd

    Very well done, as always!

  3. SugarfreeB

    Nicely done.

  4. -> Continue reading
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