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Basal Insulin Levels

Basal Insulin Therapy Is Associated With Beneficial Effects On Postoperative Infective Complications, Independently From Circulating Glucose Levels In Patients Admitted For Cardiac Surgery - Sciencedirect

Basal Insulin Therapy Is Associated With Beneficial Effects On Postoperative Infective Complications, Independently From Circulating Glucose Levels In Patients Admitted For Cardiac Surgery - Sciencedirect

Basal insulin therapy is associated with beneficial effects on postoperative infective complications, independently from circulating glucose levels in patients admitted for cardiac surgery Author links open overlay panel P.M.Piattia The effect of insulin per se on infective complications during cardiac surgery was evaluated. Eight hundred twelve patients were included. Insulin therapy decreased infections independently from glycemic levels. Basal+premeal insulin therapy is well tolerated without severe hypoglycemia cases. Although hyperglycemia is a strong predictor of postoperative infective complications (PIC), little is known about the effect of basal insulin therapy (BIT) per se on PIC. To evaluate if there is an association between BIT, independent of glucose levels, and a possible improvement of PIC during the perioperative cardiosurgery period (PCP). In 812 patients admitted for cardiac intervention and treated with a continuous intravenous insulin infusion (CIII) for hyperglycemic levels (>130mg/dl), a retrospective analysis was performed during the PCP (January 2009December 2011). Upon transfer to the cardiac surgery division, if fasting glucose was 130mg/dl, a basal+premeal insulin therapy was initiated (121 patients, group 1); for <130mg/dl, a premeal insulin alone was initiated (691 patients, group 2). Compared with group 2, group 1 showed reductions in PIC (2.48% vs 7.96%, p<0.049; odds ratio: 0.294; 95% CI: 0.1100.780), C-Reactive Protein (p<0.05) and white blood cell (p<0.05) levels despite glucose levels and CIII that were higher during the first two days after surgery (179.825.3 vs 169.510.6mg/dl, p<0.01; 0.0460.008 vs 0.0370.015U/kg/h, p<0.05, respectively). Normal glucose levels were achieved in both groups from day 3 before the discharge. The mean l Continue reading >>

Getting Down To Basals

Getting Down To Basals

To borrow a phrase from the late, great Rodney Dangerfield, “Basal insulin gets no respect.” Very few people know how to spell it correctly (basil? bazal? I mean, really!), and even fewer know what the heck it’s for. That’s a shame, because basal insulin (no “z”) is the foundation upon which insulin therapy is built. Unlike its more famous little brother bolus, which is the rapid-acting insulin given to cover those delicious carbohydrates in our diet, basal’s job is much more mundane: to match the liver’s secretion of glucose into the bloodstream (and to prevent the liver from oversecreting glucose). Everyone’s liver does it, and a healthy pancreas responds by secreting a small amount of insulin into the bloodstream every few minutes. How would we manage without basal insulin? Not so well. Because the liver is secreting glucose into the bloodstream continuously, a complete lack of insulin, even for just an hour or two, would result in a sharp rise in blood glucose level. Basal insulin also makes sure that the body’s cells are nourished with a steady supply of glucose to burn for energy. Without basal insulin, many of the body’s cells would starve for fuel. Some cells would resort to burning only fat for energy, and that leads to production of acidic waste products called ketones. The combination of dehydration (caused by high blood glucose) and heavy ketone production (from excessive fat metabolism) leads to a life-threatening condition known as diabetic ketoacidosis (DKA). Suffice it to say that basal insulin is necessary for maintaining blood glucose control, not to mention survival. So where does one find basal insulin? How much is needed? And when should it be taken? Basal options Each person’s basal insulin requirement is unique. It’s affe Continue reading >>

Insulin Basics

Insulin Basics

Diabetics need insulin therapy because they can't make their own. Insulin therapy tries to mimic natural insulin secretion — what happens automatically in non-diabetics. The ultimate goal of insulin therapy is to mimic normal insulin levels. Unfortunately, current insulin replacement therapy can only approximate normal insulin levels. Insulin therapy for type 2 diabetes ranges from one injection a day to multiple injections and using an insulin pump (continuous subcutaneous insulin infusion – CSII). The more frequent the insulin injections, the better the approximation of natural or normal insulin levels. Discuss with your medical provider the insulin regimen that is best for you. On this page you will learn about: Normal or Non-diabetic blood sugar levels and insulin release from the pancreas Natural insulin (i.e. insulin released from your pancreas) keeps your blood sugar in a very narrow range. Overnight and between meals, the normal, non-diabetic blood sugar ranges between 60-100mg/dl and 140 mg/dl or less after meals and snacks. See the picture below of blood sugar levels throughout the day in someone who does not have diabetes. To keep the blood sugar controlled overnight, fasting and between meals, your body releases a low, background level of insulin. When you eat, there is a large burst of insulin. This surge of insulin is needed to dispose of all the carbohydrate or sugar that is getting absorbed from your meal. All of this happens automatically! More About Natural Insulin Release Insulin is continuously released from the pancreas into the blood stream. Although the insulin is quickly destroyed (5-6 minutes) the effect on cells may last 1-1/2 hours. When your body needs more insulin, the blood levels quickly rise, and, the converse – when you need less, 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 >>

Unlocking The Basal Mystery

Unlocking The Basal Mystery

We all know about bolus, but do you know how basal insulin works? Here’s the inside story. Any person with diabetes on insulin therapy knows that you need insulin when you eat a meal. Using a see-saw as an analogy, food and insulin balance each other out. Too much food and not enough insulin, you have hyperglycemia. Too much insulin and not enough food, and you have hypoglycemia. But most people who use insulin also realize that it’s not just for when you eat. Folks with a pump use insulin nearly 24 hours a day, taking only short breaks for showering, swimming, or sex. Also, people who manage with multiple daily injections (MDIs) have to take two types of insulin, a short-acting bolus insulin (Humalog, Novolog or Apidra) for their meals as well as a long-acting basal insulin (Levemir or Lantus). There’s a big difference between the two, but many people with diabetes don’t understand what basal insulin is and what it means to them. They either follow doctor’s orders and take long-acting insulin without understanding exactly what’s going on in their bodies or, worse, they don’t follow doctor’s orders. Let’s look at basal insulin, what it does, and how to test your basal rate, since a little knowledge can bring an outsized peace of mind: Managing Spontaneous Sugar Basal literally means “background”, and basal insulin is the background insulin that has to be constantly infused or active in our bodies or our blood sugar spikes. Unlike previous long-acting insulins that would peak, basal insulin is programmed to keep our blood sugars stable in the absence of food. But how many of us actually understand the biology behind the basal? I’ve had Type 1 diabetes for almost 20 years, but it wasn’t until I took an Anatomy & Physiology class and spoke with se Continue reading >>

Basal Insulin Diet Guidelines

Basal Insulin Diet Guidelines

nonstarchy vegetables, such as green beans leafy greens, such as kale, chard, and spinach Refined carbohydrates, on the other hand, are digested more quickly. They spike your blood sugar soon after you eat them, especially if you eat them by themselves. To keep this from happening, avoid refined carbs, such as white rice, white bread, pasta, and white potatoes. Learn more: What is the glycemic index? Processed foods, such as sugary desserts, boxed cereals, baked goods, and packaged meals, should be eliminated as much as possible when trying to stick to a healthy eating plan. These foods are filled with hidden sugars and can be detrimental to a person with diabetes. If you have diabetes, reading food labels is key. Manufacturers are legally required to list ingredients on food labels in descending order by weight. So if you find a label with sugar as one of the top three ingredients, put it back. Look for a healthier alternative. Remember, sugar can be disguised under many names. These are all forms of sugar: Make a list of hidden sugars and keep it in your wallet or purse to make your grocery shopping trips less confusing. Keep reading: Understanding food nutrition labels According to the American Heart Association , people with diabetes, particularly type 2, have a greater chance of developing cardiovascular disease. Adding healthy fats is another step in maintaining normal blood sugar levels and decreasing your risk of heart attack or stroke. Limiting saturated fat and avoiding trans fats is another way to prevent a stroke. These are found in red meat and whole milk dairy items. Instead of frying your meat, try grilling, baking, broiling, or stir-frying. Also, cook with healthier oils, like olive oil, rather than saturated fat-laden lard or butter. If youre craving a Continue reading >>

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

Basal Insulin Types, Benefits, Dosage Information, And Side Effects

The primary job of basal insulin is to keep your blood glucose levels stable during periods of fasting, such as while you’re sleeping. While fasting, your liver continuously secretes glucose into the bloodstream. Basal insulin keeps these glucose levels under control. Without this insulin, your glucose levels would rise at an alarming rate. Basal insulin ensures that your cells are fed with a constant stream of glucose to burn for energy throughout the day. Here’s what you need to know about basal insulin medication and why it’s important for managing diabetes. Types There are three main types of basal insulin. Intermediate-acting insulin, NPH Brand-name versions include Humulin and Novolin. This insulin is administered once or twice daily. It’s usually mixed with mealtime insulin in the morning, before your evening meal, or both. It works hardest in the 4 to 8 hours after injection, and the effects start waning after about 16 hours. Long-acting insulin Two types of this insulin currently on the market are detemir (Levemir) and glargine (Lantus). This basal insulin begins working 90 minutes to 4 hours after injection and remains in your bloodstream for up to 24 hours. It may start weakening a few hours earlier for some people or last a few hours longer for others. There isn’t a peak time for this type of insulin. It works at a steady rate throughout the day. Ultra-long acting insulin In January 2016, another basal insulin called degludec (Tresiba) was released. This basal insulin begins working within 30 to 90 minutes and remains in your bloodstream for up to 42 hours. As with the long-acting insulins detemir and glargine, there isn’t a peak time for this insulin. It works at a steady rate throughout the day. Insulin degludec is available in two strengths, 1 Continue reading >>

Basal Basics

Basal Basics

Whether you use an insulin pump or take multiple daily injections of insulin, having the right basal insulin program and setting the right doses is very important. Receiving too much basal insulin, or receiving it at the wrong times, can result in frequent (and perhaps severe) hypoglycemia as well as unwanted weight gain. Receiving too little basal insulin will produce high blood sugars and make it very difficult to set appropriate mealtime bolus doses. Insulin pumps allow the greatest degree of precision in setting basal insulin levels and can produce the best control and lifestyle flexibility. Each person’s basal insulin requirement is unique, affected by factors such as body size, activity level, stage of growth, hormone levels, and the amount (if any) of internal insulin production from one’s own pancreas. During a person’s growth years (prior to age 21), basal insulin requirements tend to be heightened throughout the night. This is due to the production of large amounts of hormones (growth hormone and cortisol) that stimulate the liver to release extra glucose into the bloodstream. After the growth years, production of these hormones is reduced and limited primarily to the predawn hours. The “dawn effect”, as this is called, results in an increased secretion of glucose by the liver in the early morning. Thus, basal insulin requirements in most adults tend to peak during the early morning hours. In most cases, the daily (24-hour) dose of basal insulin is slightly less than the daily mealtime insulin. This depends on a person’s body weight and sensitivity to insulin, which is affected greatly by physical activity. The bigger you are, the more basal insulin you will need. The more active you are, the less you will need. During a person’s growth/teen year Continue reading >>

The Significance Of Basal Insulin Levels In The Evaluation Of The Insulin Response To Glucose In Diabetic And Nondiabetic Subjects

The Significance Of Basal Insulin Levels In The Evaluation Of The Insulin Response To Glucose In Diabetic And Nondiabetic Subjects

The level of insulin after an overnight fast (basal) in 37 obese and nonobese male subjects with normal and abnormal carbohydrate tolerance was directly related to the increase in insulin concentration during a 3 hr 100 g oral glucose tolerance test. Obesity, but not diabetes, was associated with an elevation of this basal insulin level. Thus obesity predicted with the magnitude of the insulin response to glucose ingestion. When the individual insulin values were expressed as per cent change from the basal level, this effect of obesity was excluded. The insulin levels of all subjects with normal carbohydrate tolerance promptly rose 5-7-fold, and reached peak values 1 hr after oral glucose. In contrast, the diabetic response (as per cent increase) was markedly reduced during the 1st hr, and maximal (but still subnormal) insulin levels were not attained until 2 hr. In all subjects the insulin response (quantitated by calculation of the area circumscribed by a plot of the per cent change in insulin with time) showed a significant inverse correlation with the glucose response. Thus increasing degrees of carbohydrate intolerance were associated with decreasing insulin responses. Elevated levels of insulin, in both the basal state and in response to glucose, were related to obesity. Click on an image below to see the page. View PDF of the complete article Continue reading >>

Rules Of Engagement For Basal Insulin Adjustment (or, Avoiding Basal Blunders!)

Rules Of Engagement For Basal Insulin Adjustment (or, Avoiding Basal Blunders!)

by gary scheiner, MS, CDE It seems like there are rules for everything these days. Rules for dating. Rules for e-mail etiquette. Even rules for raising kids. And so, it only seems fair that I get to create some rules of my own. Since nothing drives me battier than people who make ill-conceived changes to the basal settings on their insulin pumps, I think I’ll take this opportunity to offer some experience-laden insight on the subject. Before getting down to rule-writing, it should be understood that the role of basal insulin is to match the liver’s normal output of glucose, thus keeping blood glucose levels steady between meals and during sleep. The only true way to determine whether the existing basal settings are working properly is to perform fasting tests at each phase of the day and night. During a basal test, the only thing raising blood glucose should be the liver, and the only thing lowering it should be basal insulin. All other influences (food, bolus insulin, exercise activity, major stress, hormonal changes) need to be eliminated. Typically, a basal test can begin approximately four hours after the last meal and bolus, with the preceding meal being relatively healthy (not too much fat). During the test, blood glucose levels are taken every hour or two, or a CGM can be used to collect the information. The test is only stopped if the blood glucose rises much too high or drops too low. As long as it stays within a reasonable range, the test should continue. If the blood glucose varies by less than 30 mg/dl (1.7 mmol/l) during a basal test, we usually consider it steady enough to verify the basal setting during that time. Otherwise, changes are probably in order. When making basal changes, it’s important to keep the following “rules of engagement” in mi Continue reading >>

The Significance Of Basal Insulin Levels In The Evaluation Of The Insulin Response To Glucose In Diabetic And Nondiabetic Subjects*

The Significance Of Basal Insulin Levels In The Evaluation Of The Insulin Response To Glucose In Diabetic And Nondiabetic Subjects*

The level of insulin after an overnight fast (basal) in 37 obese and nonobese male subjects with normal and abnormal carbohydrate tolerance was directly related to the increase in insulin concentration during a 3 hr 100 g oral glucose tolerance test. Obesity, but not diabetes, was associated with an elevation of this basal insulin level. Thus obesity predicted with the magnitude of the insulin response to glucose ingestion. When the individual insulin values were expressed as per cent change from the basal level, this effect of obesity was excluded. The insulin levels of all subjects with normal carbohydrate tolerance promptly rose 5-7-fold, and reached peak values 1 hr after oral glucose. In contrast, the diabetic response (as per cent increase) was markedly reduced during the 1st hr, and maximal (but still subnormal) insulin levels were not attained until 2 hr. In all subjects the insulin response (quantitated by calculation of the area circumscribed by a plot of the per cent change in insulin with time) showed a significant inverse correlation with the glucose response. Thus increasing degrees of carbohydrate intolerance were associated with decreasing insulin responses. Elevated levels of insulin, in both the basal state and in response to glucose, were related to obesity. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1004K), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. Continue reading >>

How To Use Basal Insulin: Benefits, Types, And Dosage

How To Use Basal Insulin: Benefits, Types, And Dosage

Insulin is a hormone made in the pancreas that is responsible for regulating blood sugar levels. Diabetes is a condition where the body doesn't make enough insulin or can't use it properly. People diagnosed with diabetes benefit from increasing their body's natural insulin levels by injecting insulin. Different types of insulin are available. They can be classed by: how quickly they work (onset time) how long their effects last (duration) when they peak (peak time) Basal insulin is one type of insulin that is available, and it plays a vital role in managing diabetes. Contents of this article: What is basal insulin? Basal insulin is also known as background insulin. It helps to keep blood sugar levels stable during periods of fasting, such as between meals or during sleep. During these times, the body keeps releasing sugar (also known as glucose) into the bloodstream. This gives energy to the body's cells. Basal insulin helps to keep levels of this glucose in check. The insulin reaches the bloodstream several hours after injection. It keeps glucose levels constant throughout the day and night. In general, basal insulin remains in the system for 18-24 hours. Types of basal insulin There are two main types of basal insulin: Long-acting insulin This type of insulin may be recommended for several types of diabetes. It generally acts in the body for up to 24 hours, although some types can last longer than this. Depending on the type of insulin used and patient needs, long-acting basal insulin should be injected either once or twice daily. Long-acting insulin tends to have no peak activity and mimics the natural function of the pancreas. It allows for consistent delivery, keeping blood sugar levels steady throughout the day and night. The three types of long-acting insulin are Continue reading >>

What Is Basal Insulin?

What Is Basal Insulin?

The term “basal” insulin applies to insulin that is long-acting and provides a base or background of insulin throughout 24 hours. Long-acting or basal insulins include insulin glargine, sold as brand-name Lantus and Toujeo, and insulin detemir, sold as brand-name Levemir. We all need insulin in our body at all times. The amount of insulin rises and falls with meals. During prolong intervals between meals and especially overnight, insulin production returns to its background or “basal” level. But it turns out that many people have their biggest problem with blood sugar control during these times. This is because the liver releases glucose into the bloodstream to provide energy between meals. This glucose release should be accompanied by insulin from the pancreas, but in those with type 2 diabetes often the amount of insulin the body makes is much less than what is needed. These people typically awaken with high glucose levels. Normal fasting glucose levels, as measured after going at least 8 hours overnight without eating, should be less than 100. Many people who have type 2 diabetes have fasting sugars that are as high as 200 or sometimes even higher. Here is a “quick and dirty” test that I apply when deciding on what form of insulin to start: if a person has a fasting sugar that is significantly higher (i.e., 25 to 40 mg/dl) than his or her pre-dinner sugar, basal insulin is probably the right choice. If the reverse pattern is seen, basal insulin may still be appropriate, but other approaches might also be effective. Most patients with type 2 diabetes should probably be treated with basal insulin as their starting form of insulin, and often basal insulin in combination with other medications will often work for a patient over the long-term. Remember that fo 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 >>

Elevated Basal Insulin Secretion In Type 2 Diabetes Caused By Reduced Plasma Membrane Cholesterol

Elevated Basal Insulin Secretion In Type 2 Diabetes Caused By Reduced Plasma Membrane Cholesterol

Elevated Basal Insulin Secretion in Type 2 Diabetes Caused by Reduced Plasma Membrane Cholesterol Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malm, Sweden Search for other works by this author on: Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden Search for other works by this author on: Department of Clinical Sciences Malm (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., Continue reading >>

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