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What Is The Difference Between Basal And Bolus Insulin?

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FULL VERSION: https://goo.gl/APNPrA?56860

Personalized Intensification Of Insulin Therapy In Type 2 Diabetes – Does A Basal–bolus Regimen Suit All Patients?

Many patients with type 2 diabetes mellitus (T2DM) require insulin therapy. If basal insulin fails to achieve glycemic control, insulin intensification is one possible treatment intensification strategy. We summarized clinical data from randomized clinical trials designed to compare the efficacy and safety of basal–bolus and premixed insulin intensification regimens. We defined a between-group difference of ≥0.3% in end-of-study glycated hemoglobin (HbA1c) as clinically meaningful. A PubMed database search supplemented by author-identified papers yielded 15 trials which met selection criteria: randomized design, patients with T2DM receiving basal–bolus (bolus injection ≤3 times/day) vs. premixed (≤3 injections/day) insulin regimens, primary/major endpoint(s) HbA1c- and/or hypoglycemia-related, and trial duration ≥12 weeks. Glycemic control improved with both basal–bolus and premixed insulin regimens with – in most cases – acceptable levels of weight gain and hypoglycemia. A clinically meaningful difference between regimens in glycemic control was recorded in only four comparisons, all of which favored basal–bolus therapy. The incidence of hypoglycemia was signif Continue reading >>

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Popular Questions

  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!
    -Lloyd

  3. SugarfreeB

    Nicely done.

  4. -> Continue reading
read more
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WATCH FULL VERSION: https://goo.gl/Wk3nTi?86096

Basal Bolus Insulin Versus Ssri In Type 2 Diabetes Undergoing General Surgery (rabbit 2-sx)

High blood glucose levels in surgical patients with diabetes are associated with increased risk of medical complications and death. Improved glucose control with insulin injections may improve clinical outcome and prevent some of the hospital complications. In patients who have undergone surgery, high blood glucose increases the risk of wound infection, kidney failure and death. It is not known; however, what is the best insulin regimen in patients who will undergo surgery. The use of repeated injections of regular insulin is commonly used for glucose control in hospitalized patients with diabetes. Recently, the combination of Lantus® and Apidra® insulins has been shown to improve glucose control with lower rate of hypoglycemia (low blood sugar). We hypothesize that in patients with type 2 diabetes admitted to general surgery wards, treatment with once daily glargine (Lantus) plus supplemental glulisine insulin (Apidra®) will produce better glycemic control and a lower rate of hospital complications than treatment with regular insulin per sliding scale (SSRI). The present study aims to determine which insulin treatment is best for glucose control in hospitalized patients with di Continue reading >>

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Popular Questions

  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!
    -Lloyd

  3. SugarfreeB

    Nicely done.

  4. -> Continue reading
read more
Share on facebook

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Nursing Science Prevention, Education, And Disease Management 79. Basal-bolus Insulin Compared To Premixed Insulin In Cardiac Outpatients With Type 2 Diabetes

Diabetes is a highly prevalent chronic disease worldwide. It was observed inKing Abdul-Aziz Cardiac Centre (KACC) that, subjects treated with basal bolus insulin showed better glycemic control than premixed insulin. Aim: To compare the efficacy and safety of basal-bolus insulin, to premixed insulin in subjects with type 2 diabetes. Retrospective, comparison, chart review study included all subjects with type 2 diabetes in KACC followed up in the Cardiac Diabetes Clinic, between 2010 and 2015, who are treated with basal bolus insulin or premixed insulin. Data including HbA1C, body weight, and hypoglycemia events, pre and 1 year post initiation of insulin therapy, will be extracted from all subject’s medical records. Results will be compared between the two groups and analyzed using SPSS. Data for 400 patients was collected and analyzed. Patients were divided into two groups, Group (A) who received premixed Insulin 70/30 and Group (B) which included all patients who received Basal Bolus Insulin (N 170). Group A included 230 patients, 72% of subject in this group were Female with mean age of 64 years (STD 10), with mean HbA1c of 9.6% pre insulin use compared to 9.1% one year later ( Continue reading >>

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Popular Questions

  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!
    -Lloyd

  3. SugarfreeB

    Nicely done.

  4. -> Continue reading
read more

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