Basal Bolus Insulin Therapy

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Basal Bolus Insulin In Type 2 Diabetes

According to NICE recommendations, NPH (isophane) insulin or a long-acting analogue should be used when initiating insulin in type 2 diabetes patients (1). In majority of patients there is suboptimal glycaemic control even with initial insulin regiments. HbA1C was 7.5% or higher in 74% of patients 6 months after starting insulin therapy HbA1C was below 6.5% in only 24% or fewer after 1 year (1). NICE recommends that in patients whom target HbA1C with the initial regimen is not reached without problematic hypoglycaemia and: if on basal regimen should consider additional meal-time doses or switching to a premixed insulin if on premixed insulin once or twice daily, it suggests they should consider an additional meal-time injection or change to a basal regimen plus meal-time injections (1). Some proposed insulin regimes for patients with Type 2 diabetes (2): Once Daily - Intermediate regimen This may be used to supplement the daytime oral hypoglycaemic medication. Use intermediate acting insulin, which provides a low background level of insulin. Daily insulin requirements = 0.5 units / kg body weight approximately e.g. 0.5 x 72kg = 36 units Of which 50% will be basal requirement 36 x 5 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.

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