Guest Post David Mapletoft Diabetes Educator
Almost all people with type 2 diabetes will eventually need insulin. A regimen of bedtime intermediate-acting insulin in combination with daytime oral drugs is simple to start and results in rapid improvement in glycaemic control. It can be started safely in general practice and is the most practical way of implementing insulin. More HERE
What is a basal-bolus insulin regimen?
A basal-bolus injection regimen involves taking a number of injections through the day. If you are using a mixed insulin twice a day, did you realise that you are injecting 4 doses of insulin?
A basal-bolus regimen, which includes an injection at each meal, attempts to roughly emulate how a non-diabetic person’s body delivers insulin. That is, the normal response of the body when carbohydrates are ingested is for the pancreas to produce and release insulin into the bloodstream so that the glucose can be shifted into the muscle tissue for use as a source of fuel. See Link for Life: Insulin
A basal-bolus regimen may be applicable to people with type 1 and type 2 diabetes.
A basal-bolus routine involves taking a 1) longer acting form of insulin in an attempt to keep blood glucose levels on target through periods of fasting and 2) separate injections of shorter acting insulin to manage meals.
What is basal insulin?
The role of basal insulin, sometimes referred to as ‘background’ insulin, is aimed at keeping blood glucose levels at steady levels during periods of fasting.
When fasting (time when not eating e.g. overnight or between meals), the liver releases glucose into the blood and into our bloodstream, with a purpose of fueling our body’s cells.
Basal insulin is therefore used to help keep blood glucose levels on target, and to allow the cells to take in the glucose released by the liver for energy. Basal insulin is usually taken once or twice a day depending on the insulin.
Basal insulin acts over a relatively long period of time – usually between 12 and 24 hours.
What is bolus insulin?
A bolus dose is insulin that is usually taken immediately before a meal in an attempt to keep blood glucose levels on target following a meal. Bolus insulin needs to act rapidly as the meal starts to be digested. The actions of these type of insulin is usually a) it starts working to lower the bgl within 15 minutes of being injected – mimicking the role of the pancreas for people without diabetes b) last in duration for between 2-4 hours.
Bolus insulin is most often taken before meals, but it is also possible to take some during or just after a meal if the appetite is hindered by illness or e.g. the inability to predict the meals carb content if eating out.
If you think that this type of insulin regimen is for you, then talk to your diabetes educator or endocrinologist about the pros and cons for you.
Some of the advantages of a basal-bolus regimen
- One of the main advantages of a basal-bolus regimen is that it allows you to fairly closely match how your own body would release insulin if it was able to.
- It can allow you to give less insulin over the course of the day relative to a mixed dose of insulin.
- It may assist with weight management.
- If your day is irregular or you work shifts, this regimen may be helpful for you.
- If you like to count our carbs and eat different amounts of carbs relative to your situation, appetite and time restraints
Disadvantages of a basal-bolus regimen
- One notable disadvantage is that a basal-bolus regimen involves taking more insulin injections each day.
- This may prove problematic for some people more than others.
Talking to your doctor or diabetes educator about this type of insulin use may be just the thing you need.
David, Diabetes Educator