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Basal Bolus Insulin Regimen

“basal Plus” Insulin Achieves Outcomes Similar To Those Of Basal Bolus Therapy

“basal Plus” Insulin Achieves Outcomes Similar To Those Of Basal Bolus Therapy

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

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 insulin to deliver this sugar to the cells. Two important sources of glucose are carbohydrates from foods and glucose made in the liver. The liver supplies the body with glucose primarily during times when a person does not eat, both by breaking down complex sugars stored in the form of glycogen and by creating new sugar from proteins and fats in a process called gluconeogenesis. The combination of glucose from eating and glucose made by the liver provides a supply of sugar 24 hours a day. To move this sugar into the cells that need it for energy, insulin must be present 24 hours a day as well. Continue reading >>

Examples Of Insulin Initiation And Titration Regimens In People With Type 2 Diabetes

Examples Of Insulin Initiation And Titration Regimens In People With Type 2 Diabetes

Appendix 3 All people starting insulin should be counseled about the recognition, prevention and treatment of hypoglycemia. Consider a change in type or timing of insulin administration if glycemic targets are not being reached. Example A: Basal insulin (Humulin®-N, Lantus®, Levemir®, Novolin®ge NPH) added to oral antihyperglycemic agents • Insulin should be titrated to achieve target fasting BG levels of 4.0 to 7.0 mmol/L. • Individuals can be taught self-titration, or titration may be done in conjunction with a healthcare provider. • Suggested starting dose is 10 units once daily at bedtime. • Suggested titration is 1 unit per day until target is reached. • A lower starting dose, slower titration and higher targets may be considered for elderly or normal weight subjects. • In order to safely titrate insulin, patients must perform SMBG at least once a day fasting. • Insulin dose should not be increased if the individual experiences 2 episodes of hypoglycemia (BG <4.0 mmol/L) in 1 week or any episode of nocturnal hypoglycemia. • For fasting BG levels consistently <5.5 mmol/L, a reduction of 1 to 2 units of insulin may be considered to avoid nocturnal hypoglycemia. • Oral antihyperglycemic agents (especially secretagogues) may need to be reduced if daytime hypoglycemia occurs. Example B: Basal Plus Strategy - Adding bolus (prandial) insulin (Apidra®, Humalog®, NovoRapid®) once daily to optimized basal insulin therapy • When intensification of insulin therapy is necessary, start one injection of meal time insulin to either main meal or breakfast. • Starting dose is 2 to 4 units and patient can be taught self titration or dose increase can be done by HCP. • To safely increase dose, glucose levels should be measured at least prior to insulin d Continue reading >>

Novolog® (insulin Aspart Injection) 100 U/ml Indications And Usage

Novolog® (insulin Aspart Injection) 100 U/ml Indications And Usage

NovoLog® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® or one of its excipients. Never Share a NovoLog® FlexPen, NovoLog® FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device Between Patients, even if the needle is changed. Patients using NovoLog® vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia. These changes should be made cautiously under close medical supervision and the frequency of blood glucose monitoring should be increased. NovoLog® (insulin aspart injection) 100 U/mL is an insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus. NovoLog® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to NovoLog® or one of its excipients. Never Share a NovoLog® FlexPen, NovoLog® FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device Between Patients, even if the needle is changed. Patients using NovoLog® vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens. Changes in insulin strength, manufacturer, type, or method of administration may affect glycemic control and predispose to hypoglycemia or hyperglycemia. These changes should be made cautiously under close medical supervision and the frequency of blood glucose monitoring should be increased. Hypoglycemia is the most common adverse effect of insulin therapy. The timing of hypoglycemia may reflect the time-action profile of the insulin formulation. Glucose monitoring is re Continue reading >>

Sliding-scale Versus Basal-bolus Insulin In The Management Of Severe Or Acute Hyperglycemia In Type 2 Diabetes Patients: A Retrospective Study

Sliding-scale Versus Basal-bolus Insulin In The Management Of Severe Or Acute Hyperglycemia In Type 2 Diabetes Patients: A Retrospective Study

Abstract Sliding-scale and basal-bolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Although its use is not recommended, sliding-scale insulin therapy is still being used widely. The aims of the study were to compare the glycemic control achieved by using sliding-scale or basal-bolus regimens for the management of severe or acute hyperglycemia in patients with type 2 diabetes and to analyze factors associated with the types of insulin therapy used in the management of severe or acute hyperglycemia. This retrospective study was conducted using the medical records of patients with acute or severe hyperglycemia admitted to a hospital in Malaysia from January 2008 to December 2012. A total of 202 patients and 247 admissions were included. Patients treated with the basal-bolus insulin regimen attained lower fasting blood glucose (10.8±2.3 versus 11.6±3.5 mmol/L; p = 0.028) and mean glucose levels throughout severe/acute hyperglycemia (12.3±1.9 versus 12.8±2.2; p = 0.021) compared with sliding-scale insulin regimens. Diabetic ketoacidosis (p = 0.043), cardiovascular diseases (p = 0.005), acute exacerbation of bronchial asthma (p = 0.010), and the use of corticosteroids (p = 0.037) and loop diuretics (p = 0.016) were significantly associated with the type of insulin regimen used. In conclusion, type 2 diabetes patients with severe and acute hyperglycemia achieved better glycemic control with the basal-bolus regimen than with sliding-scale insulin, and factors associated with the insulin regimen used could be identified. Figures Citation: Zaman Huri H, Permalu V, Vethakkan SR (2014) Sliding-Scale versus Basal-Bolus Insulin in the Management of Severe or Acute Hyperglycemia in Type 2 Diabe Continue reading >>

Insulin Management Of Type 2 Diabetes Mellitus

Insulin Management Of Type 2 Diabetes Mellitus

Insulin therapy is recommended for patients with type 2 diabetes mellitus and an initial A1C level greater than 9 percent, or if diabetes is uncontrolled despite optimal oral glycemic therapy. Insulin therapy may be initiated as augmentation, starting at 0.3 unit per kg, or as replacement, starting at 0.6 to 1.0 unit per kg. When using replacement therapy, 50 percent of the total daily insulin dose is given as basal, and 50 percent as bolus, divided up before breakfast, lunch, and dinner. Augmentation therapy can include basal or bolus insulin. Replacement therapy includes basal-bolus insulin and correction or premixed insulin. Glucose control, adverse effects, cost, adherence, and quality of life need to be considered when choosing therapy. Metformin should be continued if possible because it is proven to reduce all-cause mortality and cardiovascular events in overweight patients with diabetes. In a study comparing premixed, bolus, and basal insulin, hypoglycemia was more common with premixed and bolus insulin, and weight gain was more common with bolus insulin. Titration of insulin over time is critical to improving glycemic control and preventing diabetes-related complications. Insulin is secreted continuously by beta cells in a glucose-dependent manner throughout the day. It is also secreted in response to oral carbohydrate loads, including a large first-phase insulin release that suppresses hepatic glucose production followed by a slower second-phase insulin release that covers ingested carbohydrates 1 (Figure 12). Clinical recommendation Evidence rating References Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia. A 17–19 Fasting glucose readings should be used to titrate basal insul Continue reading >>

Intensification Of Insulin Therapy For Type 2 Diabetic Patients In Primary Care: Basal-bolus Regimen Versus Premix Insulin Analogs

Intensification Of Insulin Therapy For Type 2 Diabetic Patients In Primary Care: Basal-bolus Regimen Versus Premix Insulin Analogs

In April 2012, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published a joint position statement regarding treatment of hyperglycemia in type 2 diabetes, “Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach” (1). As most diabetic patients (>366 million worldwide) (2) are treated by their primary family physician and not by an endocrinologist or diabetologist, the guidelines were intended to help physicians choose the best treatment for their patients. Some of the advantages of this position statement, over previous guidelines (3–8), are as follows: emphasizing the importance of individualization of treatment, widening treatment options, and stating the pros and cons of the different treatment option. However, as the statement was written by a group of world-known diabetologists, without the input of nurses, dietitians, family physicians, or the patients themselves, questions have been raised as to how “patient-centered” it actually is and how useful and relevant it is to the primary care setting. Choosing the best insulin regimen for initiation and intensification of insulin therapy in type 2 diabetic patients is still debatable both in the specialist clinic and in the primary care setting. The intention of this article is to review the data available and offer reasonable guidance regarding the selection of the preferred insulin regimen for initiation and intensification of insulin treatment, especially in a primary care setting. The ADA/EASD statement includes recommendations for the initiation and titration of insulin therapy (1). The recommendations point out three important aspects that need to be addressed when choosing or adjusting insulin regimens: the number of injections Continue reading >>

Basal-bolus Insulin Therapy

Basal-bolus Insulin Therapy

Someone with diabetes may need help controlling blood sugar in 2 ways: Insulin therapy that controls blood sugar between meals and during sleep is called long-acting or basal insulin Insulin therapy that controls blood sugar when you eat is called fast-acting or bolus insulin. On this site, we often refer to it as mealtime insulin. NovoLog® is a bolus insulin (also known as a fast-acting or mealtime insulin) Basal-bolus insulin therapy uses 2 types of insulin to closely mimic the body’s normal insulin release. In the body of a person without diabetes, insulin is released: In a steady “basal” amount, day and night, to help control blood sugar between meals and while you sleep In “bolus” bursts to help control blood sugar spikes that happen when you eat Basal-bolus insulin therapy (also called intensive insulin therapy) uses long-acting (basal) and mealtime (bolus) insulin together to closely mimic the body’s normal insulin pattern throughout the day. For people with type 2 diabetes who need more blood sugar control than basal insulin alone can provide If you have type 2 diabetes, you may already be taking a long-acting, or basal, insulin at night or in the morning (sometimes both), to help control blood sugar between meals and when you sleep. However, if your blood sugar is still too high, your diabetes care team may add a bolus insulin (such as NovoLog®) to help control blood sugar spikes that happen when you eat. What is basal-bolus therapy? (4:55 min.) A fast-acting insulin analog like NovoLog® can be taken along with a long-acting insulin for additional blood sugar control. If your health care provider tells you that you need to add a mealtime, or bolus, insulin to your care plan, this does not mean that you have failed to take care of your diabetes. E Continue reading >>

Insulin Regimens

Insulin Regimens

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. The appropriate insulin regimen for each patient with diabetes will depend on their type of diabetes and their individual needs and circumstances. Regimens which attempt to improve glycaemic control will require more active involvement of the patient, both with the number of injections and with the need for close self-monitoring of blood glucose. See the separate Diabetes Education and Self-management Programmes article. Insulin regimens should be tailored to the individual, taking into account the patient's type of diabetes, previous control, age, dexterity, eyesight, and personal and cultural preferences. Insulin is usually injected into the upper arms, thighs, buttocks or abdomen. The absorption may be increased if the limb is used in strenuous exercise after the injection. Lipodystrophy can be minimised by using different injection sites in rotation. Local allergic reactions may occur but are rare.[1] Effective patient education for people using insulin treatment is essential, including 'sick day' guidance. See also the separate Diabetes and Intercurrent Illness article. Insulin Passports and patient information booklets should be offered to patients receiving insulin.[2] Insulins are classified according to their duration of action.[3] Short-acting insulins Short-acting (soluble) insulin is usually injected 15 to 30 minutes before meals. Soluble insulin is also the most appropriate form of insulin for use in diabetic emergencies - eg, diabetic ketoacidosis and at the time of Continue reading >>

Evidence For Basal–bolus Insulin Versus Slide Scale Insulin

Evidence For Basal–bolus Insulin Versus Slide Scale Insulin

Abstract Greater understanding of hyperglycemia and its control in non-ICU patients has become ever more urgent given the high and increasing prevalence of diabetes in the general population and, hence, in hospitalized patients. It is well accepted that hyperglycemia in hospitalized patients is common and associated with profound medical consequences, longer lengths of stay, high healthcare costs, and adverse outcomes. It is a marker for poor clinical outcome and mortality. Although evidence that supports intensive glycemic control in critically ill patients is strong, glycemic control is often overlooked or insufficient in patients on general medicine and surgery services. In the face of strong evidence that glycemic control helps to improve outcomes in non-ICU patients, it is critical to consider how best to manage hyperglycemia in medical and surgical patients to develop optimum strategies for maintaining glycemic control. Currently available strategies for glycemic control include sliding-scale insulin and basal–bolus regimens. The principal difference between the two strategies is that sliding-scale insulin does not deliver adequate glycemic control to patients and addresses hyperglycemia after it has occurred, whereas a basal–bolus regimen is directed at preventing hyperglycemia. This paper explores the rationale for and implementation of a basal–bolus insulin regimen in non-critically ill hospitalized patients and in addition reviews best practices for transitions of care and discharge planning. Notes Compliance with Ethics Guidelines This paper was underwritten in part by a grant from Sanofi to the Hospital Quality Foundation to support the writing group’s efforts, including travel. All authors report receiving consulting fees from Sanofi. This article d Continue reading >>

Basal Bolus Insulin: Is It For You?

Basal Bolus Insulin: Is It For You?

Almost all people with type 2 diabetes will eventually need insulin. A regimen of bedtime intermediate-acting insulin in combination with daytime oral drugs is simple to start and results in rapid improvement in glycaemic control. It can be started safely in general practice and is the most practical way of implementing insulin. More HERE What is a basal-bolus insulin regimen? A basal-bolus injection regimen involves taking a number of injections through the day. If you are using a mixed insulin twice a day, did you realise that you are injecting 4 doses of insulin? A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person’s body delivers insulin. That is, the normal response of the body when carbohydrates are ingested is for the pancreas to produce and release insulin into the bloodstream so that the glucose can be shifted into the muscle tissue for use as a source of fuel. See Link for Life: Insulin A basal-bolus regimen may be applicable to people with type 1 and type 2 diabetes. A basal-bolus routine involves taking a 1) longer acting form of insulin in an attempt to keep blood glucose levels on target through periods of fasting and 2) separate injections of shorter acting insulin to manage meals. What is basal insulin? The role of basal insulin, sometimes referred to as ‘background’ insulin, is aimed at keeping blood glucose levels at steady levels during periods of fasting. When fasting (time when not eating e.g. overnight or between meals), the liver releases glucose into the blood and into our bloodstream, with a purpose of fueling our body’s cells. Basal insulin is therefore used to help keep blood glucose levels on target, and to allow the cells to take in the glucose released by the liver fo Continue reading >>

Basal Bolus - Basal Bolus Injection Regimen

Basal Bolus - Basal Bolus Injection Regimen

Tweet A basal-bolus injection regimen involves taking a number of injections through the day. A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person’s body delivers insulin. A basal-bolus regimen may be applicable to people with type 1 and type 2 diabetes. What is a basal-bolus insulin regimen? A basal-bolus routine involves taking a longer acting form of insulin to keep blood glucose levels stable through periods of fasting and separate injections of shorter acting insulin to prevent rises in blood glucose levels resulting from meals. What is basal insulin? The role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting. When fasting, the body steadily releases glucose into the blood to our cells supplied with energy. Basal insulin is therefore needed to keep blood glucose levels under control, and to allow the cells to take in glucose for energy. Basal insulin is usually taken once or twice a day depending on the insulin. Basal insulin need to act over a relatively long period of time and therefore basal insulin will either be long acting insulin or intermediate insulin. What is bolus insulin? A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used. Bolus insulin is often taken before meals but some people may be advised to take their insulin during or just after a meal if hypoglycemia needs to be prevented. Your doctor will be able to advise you if you have any questions as to when your bolus insulin should be taken. Advantages of a basal-bolus regimen One of t Continue reading >>

Basal-bolus Insulin May Require Fewer Increases In Daily Doses Than Other Insulin Regimens

Basal-bolus Insulin May Require Fewer Increases In Daily Doses Than Other Insulin Regimens

Basal-bolus insulin therapy allowed patients to maintain glycemic control similar to three other daily regimens but resulted in fewer increases in daily insulin doses, a study found. Researchers investigated the association between four insulin regimens and increase in HbA1c or insulin dose in a real-life clinical setting among 757 patients with type 2 diabetes who had been treated with insulin for more than one year. Patient data were derived from a diabetes registry at Tenri Hospital, a regional tertiary care teaching hospital in Japan. The insulin regimens compared in this observational study were: regimen 1, insulin glargine once daily, regimen 2, biphasic insulin twice daily, regimen 3, biphasic insulin three times daily, and regimen 4, rapid-acting insulin analogue three times daily and long-acting insulin once daily. Main outcomes were increase in HbA1c level greater than 0.5%, increase in insulin dose, addition of oral antidiabetic drugs, and weight gain, all measured at one year. HbA1c levels, total daily insulin doses, doses of concomitant oral antidiabetic drugs, body weight, and body mass index were evaluated at baseline and one year. Results were published by the Journal of Diabetes Investigation on May 11. At baseline the mean HbA1c level was 7.8% and duration of insulin therapy was 11.3 years. There were no significant differences among the regimens in the proportion of patients having their HbA1c level increase by more than 0.5% (22.8%, 24.9%, 20.7%, and 29.3% with regimens 1, 2, 3, and 4, respectively). However, a daily insulin dose increase was significantly less common among patients on regimen 4 at 38.6%, compared to 62.3%, 68.8%, and 65.3% of those on regimens 1, 2, and 3, respectively (P<0.001 for comparisons to regimen 4). Patients who received re Continue reading >>

What Is Basal-bolus Insulin Therapy For Diabetes?

What Is Basal-bolus Insulin Therapy For Diabetes?

“Basal-bolus” insulin therapy is a form of insulin treatment that is designed to mimic the natural pattern of insulin release seen in someone who is not diabetic. It is the “gold standard” of insulin treatment and it is the right approach to treating most people with type 1 diabetes and some people with type 2. Let’s start by remembering that we need glucose in our bloodstream at all times. It serves as the source of energy for all the cells in our body. But in order to use the glucose as fuel, most cells require insulin as well. The glucose ultimately all comes from our food, but the pattern of glucose fluctuation that we see over a day results from periods of eating and fasting. When we eat, our blood sugar levels rise and the body makes more insulin to compensate for this. A large amount of glucose absorbed into the body quickly is a called a “bolus,” and the rise and fall of insulin that accompanies our meals is called “bolus” insulin. When the body is not capable of making that insulin, we inject short-acting or “bolus” insulin to do the job. Short-acting or bolus insulins are so-called “regular” insulin or the brand name insulins NovoLog, Humalog and Apidra. There is also an inhaled form of bolus insulin called Afrezza which came to market in 2015. The amount of bolus insulin administered depends on the amount of carbohydrate we eat, just as the body would make more or less for larger or smaller meals. A few hours after a meal, the glucose from that meal has either been used for fuel or stored for later use. At that stage, the liver and muscles begin to release the stored glucose in a “basal” fashion, meaning “baseline” or “background.” The muscles mostly use the glucose they release inside their own cells, but the liver relea Continue reading >>

Switching To Basal-bolus Insulin Therapy Is Effective And Safe In Long-term Type 2 Diabetes Patients Inadequately Controlled With Other Insulin Regimens.

Switching To Basal-bolus Insulin Therapy Is Effective And Safe In Long-term Type 2 Diabetes Patients Inadequately Controlled With Other Insulin Regimens.

Abstract AIM: To assess in standard clinical practice the feasibility, efficacy, and safety of switching patients with long-standing type 2 diabetes (T2DM) and poor or unstable blood glucose control to basal-bolus insulin therapy. MATERIAL AND METHODS: This was a prospective, single center study including 37 patients with T2DM (age 65±8 years, 62.2% men, body mass index 28.8±6.2 kg/m2, diabetes duration 18±8 years) with poor or unstable glycemic control, who were switched to a basal-bolus insulin regimen with glargine and rapid-acting insulin analogue at the discretion of their physicians. After a group-structured outpatient diabetes training program, patients were followed in a clinical practice setting for 6 months. Clinical and biochemical variables were collected before switching and at 3 and 6 months. RESULTS: After switching to basal-bolus therapy, glycosylated hemoglobin (HbA1c) decreased from 9±1.2% to 8.1±1.2% (p<0.001) at 3 months and to 8.0±1.2% at 6 months (p<0.001) without changing total daily insulin dose. The proportion of patients with HbA1c ≥ 9% decreased from 51% to 13.8% at 3 months and to 18.9% at 6 months respectively. There was a single episode of severe hypoglycemia. No changes were seen in body weight and quality of life. The size of LDL (low density lipoprotein) particles significantly increased at 3 and 6 months, while all other lipid parameters remained unchanged. CONCLUSIONS: Our study confirmed that basal-bolus insulin therapy is feasible, effective, and safe in patients with long-standing T2DM, and does not impair their quality of life. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved. Continue reading >>

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