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What Is The Difference Between Bolus And Basal Insulin?

Why Basal-bolus Insulin Therapy May Be The Best Choice For Type 2 Diabetes

Why Basal-bolus Insulin Therapy May Be The Best Choice For Type 2 Diabetes

Many medications, both oral and injectable, exist to manage blood glucose in type 2 diabetes. Even insulin has many different formulations, including fast-acting and long-acting analogs as well as various pre-mixed combinations of faster and slower acting insulins in the same vial. This large selection of treatments is necessary because type 2 diabetes generally progresses over time from insulin resistance to outright beta cell failure. As a result, treatments must frequently be changed or added to one another in order to maintain good control. As the disease progresses, insulin might be combined with one or more oral agents, or different types of insulin might be used together to control glucose. Basal-bolus insulin therapy is one method of using different insulins together to treat diabetes. In order to understand basal-bolus insulin therapy, it is important to understand how the body uses the insulin it produces naturally. Insulin released from the pancreas helps move glucose from the bloodstream into the cells of the body, which then use the sugar for energy. Because the cells need energy all the time, the body must have not only a constant supply of glucose, but also enough insulin to deliver this sugar to the cells. Two important sources of glucose are carbohydrates from foods and glucose made in the liver. The liver supplies the body with glucose primarily during times when a person does not eat, both by breaking down complex sugars stored in the form of glycogen and by creating new sugar from proteins and fats in a process called gluconeogenesis. The combination of glucose from eating and glucose made by the liver provides a supply of sugar 24 hours a day. To move this sugar into the cells that need it for energy, insulin must be present 24 hours a day as well. Continue reading >>

“basal Plus” Insulin Achieves Outcomes Similar To Those Of Basal Bolus Therapy

“basal Plus” Insulin Achieves Outcomes Similar To Those Of Basal Bolus Therapy

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What Is Bolus Insulin? What Is Basal Insulin? Why Have My Doctors Never Talked To Me About Anything New In The Field Of Diabetes Control.

What Is Bolus Insulin? What Is Basal Insulin? Why Have My Doctors Never Talked To Me About Anything New In The Field Of Diabetes Control.

Think of the word basal as base. This is the amount of insulin you need circulating through your body all the time to release energy. You may use a long-acting insulin if you are on regular injections. If you use a pump, it will give you the calculated rate a tiny bit at a time, just as a healthy pancreas does. The pump basal rate can be changed hour by hour and can give you doses as precise as one-hundredths of a unit, according to how it is programmed. This is a giant advantage for good tight control while avoiding lows. Bolus is an extra amount of insulin that is injected for food intake. Whenever you eat carbohydrates, your body can't release the energy in the food without it. If you don't bolus when you eat, you blood glucose levels will rise to unacceptable levels. This bolus is NOT a random number of units. It is calculated for you precisely. The pump is better and easier to use for boluses as well. It has the ratio preprogrammed by your doctor. All you have to do is test your blood glucose, input the number and then enter the number of carb grams. The pump will correct for your blood glucose if necessary while giving you the insulin bolus for the food you will eat. The pump also only needs changing every other day. It contains a reservoir that you fill with insulin when you change. The cannula, a very tiny tube, that goes in your body is the way the insulin enters the body. Whether you inject or pump, you need to stick with one body part. The rates of absorption are wildly different, from 15 to 35 percent. If you choose arms, you will need more insulin. If you switch to legs or belly, you will need a lot less. The best site is the belly which absorbs the highest amount and has lots of space for moving the injections around. About every 90 days, your doctor will Continue reading >>

A1c Reduction In Type 2 Diabetes

A1c Reduction In Type 2 Diabetes

A1C was significantly reduced with Apidra® in patients with type 2 diabetes1 All efficacy variables were determined using the intent-to-treat population1 A slightly greater A1C reduction from baseline to endpoint was seen in the Apidra® group vs RHI (-0.46% vs -0.30% with RHI) (P=0.0029)1 The clinical relevance of the difference in A1C reductions between RHI and Apidra® is unknown Safety Results b Severe symptomatic hypoglycemia was defined as symptomatic hypoglycemia requiring assistance from another person and confirmed by BG <36 mg/dL or associated with prompt recovery following oral carbohydrate, intravenous glucose, or glucagon administration. All severe hypoglycemia episodes are considered as serious adverse events.1 cP=NS. Study Design1 A 26-week, randomized, open-label, active-control study compared Apidra® with RHI given premeal in 876 type 2 diabetes patients, 30 to 80 years old, with BMI <45 kg/m2 and A1C >7.5%. Both groups were given intermediate-acting basal insulin twice daily; mean baseline A1C of 7.6%. Subjects continued the same dose of prestudy OAD regimen unless hypoglycemia necessitated changes. The treatment consisted of 2 injections of Apidra® or 2 injections of RHI in addition to 2 injections of NPH. More than 2 injections of RHI or Apidra® were permitted as per investigators’ judgment. Apidra® or RHI was individually dosed as appropriate, prior to at least 2 meals a day (breakfast and dinner). Endpoint was last available measurement after start of treatment.1 Next Page Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection) Apidra® is a rapid-acting insulin analog indicated to improve glycemic control in adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes. When used as a mea Continue reading >>

Switching From Twice-daily Basal Insulin Injections To Once-daily Insulin Degludec Injection For Basal-bolus Insulin Regimen In Japanese Patients With Type 1 Diabetes: A Pilot Study

Switching From Twice-daily Basal Insulin Injections To Once-daily Insulin Degludec Injection For Basal-bolus Insulin Regimen In Japanese Patients With Type 1 Diabetes: A Pilot Study

International Journal of Endocrinology Volume 2015 (2015), Article ID 176261, 6 pages 1Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan 2Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan 3Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan 4Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyou-ku, Tokyo 113-8421, Japan Academic Editor: Kristin Eckardt Copyright © 2015 Yuka Tosaka et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract The aim of this study was to investigate the efficacy of insulin degludec used for basal-bolus insulin regimen after switching from twice-daily basal insulin in Japanese patients with type 1 diabetes mellitus. The subjects were 22 type 1 diabetes patients treated with basal-bolus insulin regimen with twice-daily basal insulin. Basal insulin was switched to once-daily injection of insulin degludec with 10% dose reduction. HbA1c and fasting plasma glucose (FPG) were measured before and 12 weeks after switching. The frequency of hypoglycemic episodes, standard deviation (SD) of blood glucose, and mean of daily difference (MODD) were evaluated by continuous glucose monitoring (CGM) before and 4 weeks after switching. HbA1c and FPG before and 12 weeks after switching were comparable (HbA1c 8.5 ± 1.4 versus 8.7 ± 1.6%, ; FPG 203.2 ± 81.2 versus 206.5 ± 122.4 mg/dL, ). The fre Continue reading >>

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

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 total of 375 subjects (aged 18 to 80 years) with type 2 diabetes treated with diet, oral antidiabetic agents (OADs), or low-dose insulin (≤4 units/kg/day) were enrolled. Prior to randomization, BG was between 140 and 400 mg/dL; subjects were recruited when BG was >140 mg/dL. OADs were stopped at admission. Randomization was in a 2:2:1 ratio: Basal bolus: glargine once daily, glulisine before meals, corrective doses of glulisine by sliding scale for BG >140 mg/dL Basal plus: glargine once daily, corrective glulisine given by sliding scale before meals for BG >140 mg/dL Regular SSI (no basal insul Continue reading >>

Insulin Pump

Insulin Pump

An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin infusion therapy. The device configuration may vary depending on design. A traditional pump includes: the pump (including controls, processing module, and batteries) a disposable reservoir for insulin (inside the pump) a disposable infusion set, including a cannula for subcutaneous insertion (under the skin) and a tubing system to interface the insulin reservoir to the cannula. Other configurations are possible. For instance, more recent models may include disposable or semi-disposable designs for the pumping mechanism and may eliminate tubing from the infusion set. An insulin pump is an alternative to multiple daily injections of insulin by insulin syringes or an insulin pen and allows for intensive insulin therapy when used in conjunction with blood glucose monitoring and carb counting. Medical uses[edit] Advantages[edit] Users report better quality of life (QOL) compared to using other devices for administering insulin. The improvement in QOL is reported in type 1 and insulin-requiring type 2 diabetes subjects on pumps.[1] The use of rapid-acting insulin for basal needs offers relative freedom from a structured meal and exercise regime previously needed to control blood sugar with slow-acting insulin.[citation needed] Programmable basal rates allow for scheduled insulin deliveries of varying amounts at different times of the day. This is especially useful in controlling events such as the dawn phenomenon resulting in less low blood sugar during the night.[2] Many users feel that bolusing insulin from a pump is more convenient and discreet than injection.[2][3] Insulin pumps make it possible to deliver more pre Continue reading >>

Advancing Beyond Basal Insulin Therapy In Patients With Type 2 Diabetes

Advancing Beyond Basal Insulin Therapy In Patients With Type 2 Diabetes

Abstract: An interesting report from the Quality of Care and Outcomes in Type 2 Diabetes (QuED) Study Group1 demonstrated that a physician’s beliefs about glycemic control directly correlated with the degree of metabolic control achieved by his or her patients with type 2 diabetes (T2D). Only 14% of physicians targeted fasting plasma glucose (FPG) at <110mg/dl and about 40% thought that an FPG >140mg/dl was acceptable. Surprisingly, there was no difference between physicians in general practice and diabetologists with respect to the goals for fasting glucose. When patient performance was subsequently analyzed, average hemoglobin A1c (A1c) was lowest among patients whose physicians emphasized tight glucose control, and A1c remained at approximately 8% in patients managed by physicians with suboptimal expectations. It might be the case that the most significant barrier to early and aggressive management of T2D is the healthcare professional. People with T2D will eventually need insulin therapy because oral agents fail over time. Although we have data spanning decades demonstrating that tight control of glucose decreases end organ damage from diabetes,2-4 initiation of insulin therapy is often delayed for years.5 It is a common perception that insulin represents the last therapeutic measure and should be postponed for as long as possible. More recently, the Diabetes Attitudes, Wishes, and Needs (DAWN) study documented that there was much resistance to starting insulin therapy on the part of patients, nurses, and physicians.6 An analysis of National Health and Nutrition Examination Survey (NHANES) data by Koro et al.7 reported that only 36% of patients with T2D were treated to an A1c goal of <7%. Further, only 27% of patients received insulin (16% insulin only and 11% ins Continue reading >>

Basal-bolus Insulin Therapy

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 >>

The Difference Between Basal And Bolus Insulin

The Difference Between Basal And Bolus Insulin

In order to understand the role of both basal and bolus insulin, it is important to first understand how the body naturally uses glucose and insulin. When food is eaten, it is digested and converted to glucose (sugar) so it can be used for energy. Virtually every cell in the body, including your brain, needs glucose to function properly. The hormone ​insulin is needed to carry that glucose into cells in all parts of the body so that it can be used for energy. Some of this glucose is stored in the liver as a reserve fuel (called glycogen) that is released when glucose is not available through food. So, between the glucose that is consumed through food and what is gradually released from the liver, the body gets a constant supply of glucose. This also means that there needs to be a constant supply of insulin in the body to keep the amount of glucose in balance. Since more glucose is produced after a meal, the pancreas secretes more insulin. When the amount of glucose is lower, such as between meals or at night, there is less insulin needed -- but there is always at least a small amount of insulin present in the body at all times. Defining Basal and Bolus Insulin Basal insulin is the background insulin that is normally supplied by the pancreas and is present 24 hours a day, whether or not the person eats. Bolus insulin refers to the extra amounts of insulin the pancreas would naturally make in response to glucose taken in through food. The amount of bolus insulin produced depends on the size of the meal. In a person with type 1 diabetes, the pancreas no longer automatically makes insulin regardless of the intake of glucose. The beta cells that produce the insulin have largely shut down. Both the basal, or long-term background insulin, and the bolus, or quick bursts of in 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 >>

Basal Bolus Versus Basal Insulin In Type 2 Diabetes Mellitus (dm) (basal Plus)

Basal Bolus Versus Basal Insulin In Type 2 Diabetes Mellitus (dm) (basal Plus)

High blood glucose levels in medical and surgery patients with diabetes are associated with increased risk of in-hospital complications and death. Improved glucose control with insulin injections may improve clinical outcome and prevent some of the hospital complications. Numerous studies have shown that 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). The investigators' recent preliminary data also indicate that a single daily dose of glargine plus corrective doses of glulisine before meals if needed (Basal Plus) is effective in the management of medical and surgical patients with type 2 diabetes mellitus (T2DM). The average daily blood glucose (BG) levels in patients treated with Basal Plus is equivalent to levels in patients treated with Basal Bolus with glargine once daily plus glulisine before meals (basal bolus regimen). The mean daily BG levels in patients treated with basal plus are lower than those reported in patients treated with sliding scale regular insulin (SSRI). Accordingly, the present study aims to determine which insulin treatment is best for glucose control in hospitalized patients with diabetes admitted to general medicine wards. Glargine, glulisine, and regular insulins are approved for use in the treatment of patients with diabetes by the FDA. A total of 375 subjects with type 2 diabetes will be recruited in this study. The sites for this stud Continue reading >>

What Is The Difference Between Basal Insulin And Bolus Insulin?

What Is The Difference Between Basal Insulin And Bolus Insulin?

What is the Difference between Basal insulin and Bolus insulin? The Essential Guide to Prescription Drugs, Update on Insulins Basal insulin refers to the insulin required to control your blood sugar in the absence of food intake. A certain amount of insulin is always necessary to keep the blood sugar in the normal range, even in the absence of eating for prolonged periods. Without any insulin in the body, the starch, fat, and protein in the body will break down with severe health consequences, as occurs in people with type 1 diabetes. The amount of insulin that the body requires in the absence of food intake is known as the basal requirement and it is provided by the one or two injections of long-acting insulin that most diabetics give themselves each day. If a person is using an insulin pump, then it is covered by the basal setting on the pump. Modern insulin pumps offer several basal settings in each 24-hour period, as the basal insulin production in a healthy individual varies over the course of the day, being higher in the 2-to 3-hour period before arising in the morning, for example. Bolus insulin refers to the insulin required to remove the energy derived from a meal from the bloodstream and into the tissues, to replenish energy stores. This is typically provided by the short-acting insulin injection given just prior to eating or by the bolus setting for patients on an insulin pump. Recently developed and marketed forms of insulin very closely match the pattern of insulin production from the pancreas itself in response to food. In this way, they are able toprevent the blood sugar from rising excessively after a meal, while also preventing the occurrence of low blood sugar after the glucose from the meal has been cleared from the bloodstream. The latest insulin pu 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 >>

What Is Insulin? Everything To Know If You Have Diabetes

What Is Insulin? Everything To Know If You Have Diabetes

When you think about diabetes in a general sense, your mind might immediately flash to finger pricks. But while insulin therapy is common, it’s not for everyone who has been diagnosed with the disease. Indeed, according to the Centers for Disease Control and Prevention (CDC), only 18 percent of adults with the disease take insulin to manage diabetes, while 13 percent take insulin and oral medications. If you have type 2 diabetes, it’s important to understand the basics on insulin before making a decision with your doctor about whether you need it to control your blood sugar — including what it is, what it does, what its potential benefits are, and how to overcome the fear of finger pricks if you’ve been prescribed the therapy. What Does the Pancreas Do, and How Does Insulin Affect Blood Sugar Levels? The pancreas, a gland located deep in our abdomen, releases the hormone insulin. Insulin’s primary purpose is to help transport glucose, or blood sugar, to our liver, muscle, and fat cells to be used for energy or to be stored for later use, according to the National Institute of Diabetes and Digestive and Kidney Diseases. In people without diabetes, this process works smoothly, with the pancreas meeting the body’s demands for insulin and that sufficient insulin transporting glucose to cells. Consequently, blood sugar levels stay within a normal range. But when insulin resistance occurs, the body’s cells don’t respond correctly to insulin. With this condition — which can also occur in the absence of type 2 diabetes — the pancreas’s beta cells attempt to release more and more insulin to ferry glucose to cells. When beta cells aren’t able to meet the body’s demands for insulin, blood sugar accumulates, leading to diabetes and other health issues. How Continue reading >>

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