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What Is The Difference Between Bolus And Basal Insulin?

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CONTINUE WATCHING: https://goo.gl/Wk3nTi?60341

Randomized Study Comparing Basal Bolus With Basal + Correction Insulin Regimen For Hospital Management Of Patients With Type 2 Diabetes: Basal Plus Trial

Umpierrez GE, Smiley D, Hermayer K, et al. Randomized study comparing a basal bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: Basal Plus Trial. Diabetes Care. 2013;36(8):2169-2174. Exclusive! Vivian A. Fonseca, MD, provides expert commentary on the Basal Plus Trial. Click here. Background Glycemic improvement in critically ill patients can reduce hospital complications, hospital stay, and mortality. A basal bolus regimen shows better mean daily blood glucose (BG) and a higher amount of BG within target range vs sliding-scale insulin (SSI) for hospitalized patients with type 2 diabetes. Basal bolus is the preferred insulin regimen for patients with diabetes not in the intensive care unit per clinical guidelines. But, use is limited due to the complexity of the regimen and fear of hypoglycemia. In this study, Umpierrez and colleagues explored the hypothesis that a single daily dose of basal insulin plus one other corrective dose of glulisine as needed with a meal might result in similar glycemic control and a lower rate of hypoglycemia than a basal bolus regimen. (Click here for slide) Design A tota 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

Cost-effectiveness Analysis Of Ideglira Versus Basal-bolus Insulin For Patients With Type 2 Diabetes In The Slovak Health System

4 Barnaby Hunt5 1Pharm-In, Ltd., 2Novo Nordisk Ltd., Bratislava, Slovakia; 3Novo Nordisk Ltd., Madrid, Spain; 4Novo Nordisk nv, Brussels, Belgium; 5Ossian Health Economics and Communications, Basel, Switzerland Aims: To investigate the cost-effectiveness of once-daily insulin degludec/liraglutide (IDegLira) versus basal-bolus therapy in patients with type 2 diabetes not meeting glycemic targets on basal insulin from a healthcare payer perspective in Slovakia. Methods: Long-term clinical and economic outcomes for patients receiving IDegLira and basal-bolus therapy were estimated using the IMS CORE Diabetes Model based on a published pooled analysis of patient-level data. Results: IDegLira was associated with an improvement in quality-adjusted life expectancy of 0.29 quality-adjusted life years (QALYs) compared with basal-bolus therapy. The average lifetime cost per patient in the IDegLira arm was EUR 2,449 higher than in the basal-bolus therapy arm. Increased treatment costs with IDegLira were partially offset by cost savings from avoided diabetes-related complications. IDegLira was highly cost-effective versus basal-bolus therapy with an incremental cost-effectiveness ratio of EUR 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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I wrote a program to help me calculate correction insulin dosages with meals.

Analysis Of Guidelines For Basal-bolus Insulin Dosing: Basal Insulin, Correction Factor, And Carbohydrate-to-insulin Ratio

Objective: To analyze and compare the underlying mathematical models for basal-bolus insulin-dosing guidelines in patients with type 1 diabetes in a retrospective controlled study. Methods: Algebraic model-development yielded several systems of models with unknown constants, including 3 systems currently in use. These systems were compared for logic and consistency. One of these systems was the accurate insulin management (AIM) system, which we developed in the setting of our large endocrine practice. Our database consisted of retrospective clinical records for a 7-month period. During this time, correction factor (CF), carbohydrate-to-insulin ratio (CIR), and basal insulin were being adjusted incrementally by titration. The variables studied were height, body weight in pounds (BWlb), CF, CIR, hemoglobin A1c (A1C), basal insulin, and 6-day mean total daily dose of insulin (TDD). The values of the variables used in the study were those determined on arrival of the patients at the office. The last 6 TDDs were entered into the database, and the mean was calculated by formulas within the database. We sorted our database into 2 groups, a well-controlled test group (n = 167; A1C ≤7%, t 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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