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 >>
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 >>
Nice - Insulin Therapy In Type 1 Diabetes - General Practice Notebook
NICE - insulin therapy in type 1 diabetes multiple daily injection basal-bolus insulin regimens should be offered rather than twice-daily mixed insulin regimens, as the insulin injection regimen of choice for all adults with type 1 diabetes twice-daily insulin detemir should be offered as basal insulin therapy for adults with type 1 diabetes consider, as an alternative basal insulin therapy for adults with type 1 diabetes: an existing insulin regimen being used by the person that is achieving their agreed targets once-daily insulin glargine or insulin detemir if twice-daily basal insulin injection is not acceptable to the person, or once-daily insulin glargine if insulin detemir is not tolerated rapid-acting insulin analogues injected before meals should be offered, rather than rapid-acting soluble human or animal insulins, for mealtime insulin replacement for adults with type 1 diabetes do not advise routine use of rapid-acting insulin analogues after meals for adults with type 1 diabetes if an adult with type 1 diabetes has a strong preference for an alternative mealtime insulin, respect their wishes and offer the preferred insulin a twice-daily human mixed insulin regimen for adults with type 1 diabetes can be considered if a multiple daily injection basal-bolus insulin regimen is not possible and a twice-daily mixed insulin regimen is chosen a trial of a twice-daily analogue mixed insulin regimen can be considered if an adult using a twice-daily human mixed insulin regimen has hypoglycaemia that affects their quality of life for adults with erratic and unpredictable blood glucose control (hyperglycaemia and hypoglycaemia at no consistent times), rather than a change in a previously optimised insulin regimen, the following should be considered: Continue reading >>
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Basal-bolus Insulin Therapy In Type 1 Diabetes: Comparative Study Of Pre-meal Administration Of A Fixed Mixture Of Insulin Lispro (50%) And Neutral Protamine Lispro (50%) With Human Soluble Insulin.
Abstract AIMS: To ascertain whether pre-meal administration of 50% insulin lispro and 50% neutral protamine lispro (NPL), given as a fixed mixture (Humalog Mix50, human soluble (regular) insulin as a basal-bolus regimen in people with Type 1 diabetes. Both regimens included bedtime human isophane (NPH) insulin. METHODS: This was a multinational, multicentre, randomized, open-label, two-period crossover comparison of two insulin treatments for two 12-week periods in 109 patients with Type 1 diabetes. The protocol provided preliminary evaluations of dose requirements and recommendations for insulin dose adjustment when switching regimens on the basis of blood glucose (BG) values. Eight-point BG profiles, frequency of hypoglycaemia, HbA1c, insulin dose, time of injection, and frequency of snacking were assessed during each treatment. RESULTS: Total daily insulin dose was similar for both treatments, but the total pre-meal doses were higher (P < 0.001) and the bedtime dose of isophane was lower (P < 0.001) with Mix50. The pre-meal dose before breakfast and lunch, although statistically different (P = 0.006 and P < 0.001, respectively), was of similar magnitude, but the pre-evening meal dose was higher with Mix50 (P < 0.001). Median (interquartile range) time of insulin injection before meals was: Mix50 4.2 (25th percentile = 1.0; 75th percentile = 6.3) min, human soluble insulin 24.6 (25th percentile = 16.6; 75th percentile = 30.0) min. Pre-meal and bedtime BG concentrations did not differ between treatments. The BG 2 h after the evening meal was lower with Mix50 (8.40 +/- 2.95 mmol/l vs. 9.60 +/- 3.47 mmol/l) (P = 0.049). BG after breakfast and lunch, mean HbA1c, frequency of hypoglycaemia, frequency of snacks, and body weight were not different. CONCLUSION: The use of Mix Continue reading >>
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 >>
Designing An Insulin Regimen
Intensive Insulin Therapy is the standard method of insulin replacement. This page includes a list of what your medical provider should prescribe when designing an insulin regimen for you. The main goal in designing an insulin regimen is to mimic how the body normally releases insulin. When you have type 1 diabetes, Intensive Insulin Therapy most closely mimics natural insulin production and is the standard method of insulin replacement. For Intensive Regimens: When you are intensively managed with insulin your medical provider will prescribe an insulin regimen for you, but these are the general principles: Your medical provider should prescribe: A basal or background insulin dose This will be prescribed as one or two injections of long acting insulin, or, if you are using an insulin pump, a daily infusion rate of continuous, small amounts of rapid acting insulin. The background/basal insulin dose is usually the same day to day. With an insulin pump you do have the option of temporarily changing the background rate for a few hours – up or down as needed! A bolus insulin dose to cover the sugar or carbohydrate in your food This will be presented as an insulin to carbohydrate ratio( I:CHO). The I:CHO ratio tells you how many grams of carbohydrate can be covered by one unit of rapid acting insulin. You will need to calculate how much carbohydrate you will eat, and take a dose of insulin that matches the food. A bolus insulin dose to bring your blood sugar back to the normal range A high blood sugar correction bolus insulin dose to bring your blood sugar back into the target range. This will be presented as a correction factor. This correction factor refers to how much your blood sugar will drop after 1 unit of insulin rapid acting insulin. When your blood sugar is too hi Continue reading >>
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 >>
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Calculating Insulin Dose
You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio.The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high blood Continue reading >>
Type 1 Diabetes | Treatment Summary | Bnf Provided By Nice
Type 1 diabetes describes an absolute insulin deficiency in which there is little or no endogenous insulin secretory capacity due to destruction of insulin-producing beta-cells in the pancreatic islets of Langerhans. This form of the disease has an auto-immune basis in most cases, and it can occur at any age, but most commonly before adulthood. Loss of insulin secretion results in hyperglycaemia and other metabolic abnormalities. If poorly managed, the resulting tissue damage has both short-term and long-term adverse effects on health; this can result in retinopathy, nephropathy, neuropathy, premature cardiovascular disease, and peripheral arterial disease. Typical features in adult patients presenting with type 1 diabetes are hyperglycaemia (random plasma-glucose concentration above 11mmol/litre), ketosis, rapid weight loss, a body mass index below 25kg/m2, age younger than 50years, and a personal/family history of autoimmune disease (though not all features may be present). Treatment is aimed at using insulin regimens to achieve as optimal a level of blood-glucose control as is feasible, while avoiding or reducing the frequency of hypoglycaemic episodes, in order to minimise the risk of long-term microvascular and macrovascular complications. Disability from complications can often be prevented by early detection and active management of the disease (see Diabetic complications ). The target for glycaemic control should be individualised for each patient, considering factors such as daily activities, aspirations, likelihood of complications, adherence to treatment, comorbidities, occupation and history of hypoglycaemia. A target HbA1c concentration of 48mmol/mol (6.5%) or lower is recommended in patients with type 1 diabetes. Blood-glucose concentration should be moni Continue reading >>
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Effectiveness And Safety Of Basal-bolus Therapy (insulin Glargine+insulin Glulisine) In Patients With Type 1 Diabetes Previously Uncontrolled On Any Insulin Regimen: Multinational Phase-iv Study
Effectiveness and safety of basal-bolus therapy (insulin glargine+insulin glulisine) in patients with type 1 diabetes previously uncontrolled on any insulin regimen: multinational phase-IV study Boudiba A 1 , Al-Arouj M 2 , Robertson LI 3 , Chantelot JM 4 , Al-Rubeaan KA 5 & Charpentier G 6 * 1 Diabetology Department, Mustapha University Hospital, Algiers, Algeria 2 Dasman Diabetes Institute, Dasman, Arabian Gulf street, Kuwait 3 Dot Shuttleworth Centre for Diabetes, Parklands Hospital, Durban, Republic of South Africa 5 Strategic Center for Diabetes Research, University Diabetes Centre, King Saud University, Riyadh, Saudi Arabia 6 Department of Medicine, Sud-Francilien Hospital, Corbeil-Essonnes, France Department of Medicine, Sud-Francilien Hospital Introduction: Intensive insulin therapy can improve glycemic control and outcomes in patients with Type 1 diabetes as compared to conventional therapy. This study was conducted to evaluate effectiveness and safety of combination of insulin glargine once daily and insulin glulisine thrice daily in patients with type-1-diabetes mellitus previously uncontrolled on other insulin therapies. Methods: This phase-IV, international, open-label, study was conducted in adult type-1-diabetes mellitus patients with glycated hemoglobin between 8%-10%. Study period included a 2-week run-in period and a 24-week treatment period. Change in glycated hemoglobin, fasting blood glucose, 7-point blood glucose mean profile and insulin dose from baseline to week 12 and 24 were evaluated. Safety was assessed by occurrence of adverse events primarily hypoglycemia. Descriptive statistics were used for analysis. Results: From November 2012 to January 2013, 295 patients screened out of which 206 patients were treated. The mean (SE) reduction in glyca Continue reading >>
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Selecting An Insulin Program For Type 1 Diabetes
For people with Type 1 diabetes, is there really anything more personal and significant in your life than your insulin program? In a way, your insulin program defines your lifestyle. It can either dictate your meal, sleep, and activity schedules, or it can set you up for successful control of your diabetes. Unfortunately, most people are given little choice or education on how to select the insulin program that best meets their needs. As a matter of fact, many people probably put more thought and effort into choosing a car — perhaps because they have a better idea of what they’re looking for. So what should you look for in an insulin program, and how do you know if the one you’re following is really the best one for you? Read on for some tips on this important decision. What’s in an insulin program? Every insulin program for people with Type 1 diabetes should include a basal, or “background,” insulin. Basal insulin is necessary to cover the liver’s secretion of glucose throughout the day and night, which provides the cells with a continuous supply of glucose to burn for energy. Insufficient basal insulin at any time will result in a sharp rise in blood glucose level and can also lead to the buildup of ketones, acidic by-products of fat-burning that can accumulate in large amounts if no glucose is being burned simultaneously. If high blood glucose and ketones are not treated promptly, a life-threatening condition called diabetic ketoacidosis can develop. Each person’s basal insulin requirements are unique, but typically they are higher during the early morning and lower in the middle of the day. This is due to the nighttime production of blood-sugar-raising hormones and to the enhanced insulin sensitivity that comes with daytime physical activity. Basal i Continue reading >>
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Insulin Regimens And Therapies
Tweet There are a number of different insulin regimens to fit in with the varying requirements of different people with diabetes. Insulin regimens currently available range from the once-daily insulin regimen for type 2 diabetes, through multiple daily injections, to insulin pump therapy for people with type 1 diabetes. Once-daily insulin regimen As the name implies, a once-daily insulin regimen involves taking a single dose of insulin each day. The regimen is suitable for people with type 2 diabetes who are unable to produce enough of their own insulin to control their diabetes. People on this regimen will need to take tablets in addition to the insulin. A once daily regimen can either involve taking a long acting peakless insulin or an intermediate NPH insulin. A long acting peakless insulin is appropriate in people with hyperglycemia through the day and night, and is a useful regimen in people who require assistance in taking injections. An intermediate insulin dose is suitable for people who experience high blood glucose overnight and in the morning but better during the day. In this case, the insulin dose will be taken before bed. Once daily insulin regimen Twice daily insulin regimen Twice daily insulin regimens may be suitable for people with type 1 and type 2 diabetes. It is important that people on a twice daily regimen keep to a consistent daily routine that includes three meals a day. A twice daily insulin regimen is described as being biphasic because it has two phases of activity. At each injection you will take a mixture of short acting and intermediate acting insulin. The insulin will either need to be manually mixed via syringe or, alternatively, you may take pre-mixed insulin. In type 1 diabetes, a twice daily regimen is suitable in people who have a co Continue reading >>
Optimized Basal-bolus Insulin Regimens In Type 1 Diabetes: Insulin Glulisine Versus Regular Human Insulin In Combination With Basal Insulin Glargine
Objective: To compare the efficacy and safety of insulin glulisine (GLU), a new rapid-acting insulin analogue, injected 0 to 15 minutes before or immediately after meals, with regular human insulin (RHI), injected 30 to 45 minutes before meals. Methods: Patients with type 1 diabetes (N = 860) received once-daily insulin glargine and subcutaneous injections of either GLU (premeal or postmeal) or premeal RHI in this open-label, randomized, controlled, multicen-ter, parallel-group, 12-week study. Results: Baseline to endpoint changes in mean gly-cated hemoglobin (as A1c equivalents) (A1c) occurred in the premeal GLU, postmeal GLU, and premeal RHI groups (-0.26%, -0.11%, and -0.13%, respectively). The reduction in A1c was greater for the premeal GLU group in comparison with the RHI group (P = 0.02) and the post-meal GLU group (P = 0.006); no significant between-treatment difference was found for postmeal GLU versus RHI. Overall, blood glucose profiles were similar in all 3 treatment groups but were significantly lower for premeal GLU 2-hour postbreakfast measurements (premeal versus postmeal GLU, P = 0.0017; premeal GLU versus RHI, P = 0.0001) and 2-hour postdinner measurements (premeal GLU versus RHI, P = 0.0001; premeal versus postmeal GLU, P = 0.0137). Severe hypoglycemic episodes were comparable for premeal GLU, postmeal GLU, and pre-meal RHI groups (8.4%, 8.4%, and 10.1%, respectively). Body weight increased (+0.3 kg) in the RHI and premeal GLU groups; however, weight decreased in the postmeal GLU group (-0.3 kg; between-treatment difference, P = 0.03). Conclusion: Better A1c reductions were obtained with premeal GLU, but postmeal administration of GLU was as safe and effective as premeal GLU or RHI in combination with insulin glargine and was not associated with weigh Continue reading >>
Managing Your Diabetes: Your Basal-bolus Insulin Plan
Keeping your blood glucose levels in check starts with your basal-bolus insulin plan. This plan consists of using short-acting insulin to prevent a rise in blood glucose after eating meals and a longer-acting insulin to keep blood glucose steady during periods of fasting, such as when you’re sleeping. This plan may require a number of injections throughout the day in order to mimic the way a non-diabetic person’s body receives insulin, unless you’re on pump therapy or using intermediate-acting insulin instead of long-acting insulin. Bolus insulin There are two types of bolus insulin: rapid-acting insulin and short-acting insulin. Rapid-acting insulin is taken at mealtimes and starts working in 15 minutes or less. It peaks in 30 minutes to 3 hours, and remains in the bloodstream for up to 3 to 5 hours. Short-acting or regular insulin is also taken at mealtimes, but it begins working about 30 minutes after the injection, peaks in 2 to 5 hours and stays in the bloodstream for up to 12 hours. Along with these two types of bolus insulin, if you’re on a flexible insulin schedule, you need to calculate how much bolus insulin you need. You’ll need insulin to cover carbohydrate intake as well as insulin to “correct” your blood sugar. People on a flexible dosing schedule use carbohydrate counting to determine how much insulin they need to cover the carbohydrate content of their meals. This means you would take a certain number of insulin units per a certain amount of carbohydrate. For example, if you need 1 unit of insulin to cover 15 grams of carbohydrate, then you would take 3 units of insulin when eating 45 grams of carbohydrate. Along with this insulin, you may need to add or subtract a “correction amount.” If your glucose level is a certain amount higher or Continue reading >>
How To Manage Diabetes With Basal-bolus Insulin Therapy
Diabetes is a disease that affects the way the body produces and uses insulin. Basal-bolus insulin therapy is a way of managing this condition. In type 1 diabetes, the production of insulin is affected. In type 2 diabetes, both the production and use of insulin are affected. In people without diabetes, insulin is produced by the pancreas to keep the body's blood sugar levels under control throughout the day. The pancreas produces enough insulin, whether the body is active, resting, eating, sick, or sleeping. This allows people without diabetes to eat food at any time of the day, without their blood sugar levels changing dramatically. For people with diabetes, this doesn't happen. However, a similar level of blood sugar control can be achieved by injecting insulin. Injections can be used throughout the day to mimic the two types of insulin: basal and bolus. People without diabetes produce these throughout the day and at mealtimes, respectively. What is a basal-bolus insulin regimen? A basal-bolus insulin regimen involves a person with diabetes taking both basal and bolus insulin throughout the day. It offers them a way to control their blood sugar levels. It helps achieve levels similar to a person without diabetes. Advantages There are several advantages to using a basal-bolus insulin regimen. These include: flexibility as to when to have meals control of blood sugar levels overnight they are helpful for people who do shift work they are helpful if travelling across different time zones Disadvantages The downsides to a basal-bolus regimen are that: people may need to take up to 4 injections a day adapting to this routine can be challenging it can be hard to remember to take the injections it can be hard to time the injections it's necessary to keep a supply of insulin w Continue reading >>
