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A Patient Guide For Basal Bolus Insulin Regimen

What is Basal- Bolus Insulin regimen?

There are three components to a basal-bolus insulin regimen. A basal insulin, a bolus insulin, and a correction insulin. Each of the insulins are described in more detail below.

Basal insulin is typically referred to as long acting insulin.1 Basal insulin lasts for approximately twenty-four hours.1 Also, basal insulin helps keep your fasting blood glucose levels under control since you typically take this insulin at night.1The two most common types of basal insulin are glargine (Toujeo) and detimir (Levimir).1

However, if you are taking basal insulin, your doctor will most likely prescribe you a bolus insulin medication, which is typically referred to as short acting or rapid acting insulin.1 Bolus insulin medications usually last for two to four hours and is usually administered thirty minutes before meals.1 The most common types of bolus insulin medications include, Novorapid, Humalog, and Apidra.1

Sometimes you may see a correction insulin that may be administered with the basal-bolus insulin in order to control your hyperglycemia. Rapid acting formulations are the most common type of correction insulin administered to patients. Correction insulin may be administered with your bolus insulin.

How is Basal Bolus Insulin Calculated?

First a total daily dose is calculated as seen below. Basal insulin is about 50% of the total daily dose. The other 50% of the total daily dose is the bolus insulin, which is then divided by three to get a dose before each meal.

 

Table 1. Sample Order for Subcutaneous Insulin in a Hospitalized Patient
Table 1. Sample Order for Subcutaneous Insulin in a Hospitalized Patient

 

Who Uses Basal Bolus Insulin?

Patients who have type two diabetes that are unable to control their diabetes with other insulin regimen medications will typically be prescribed a basal-bolus insulin regimen.3 This regimen may also be used in patients with type one diabetes.

What is the Efficacy of Basal Bolus Insulin?

In review of the literature, basal bolus Insulin is as effective as sliding scale insulin in patients with type two diabetes.2 Patients experience the same effects for basal insulin compared to sliding scale insulin and also experienced fewer adverse reactions such as hypoglycemia and
weight gain.2

Advantages/Disadvantages of Using Basal-Bolus Insulin

The advantages in using a basal-bolus insulin regimen includes flexibility when to have meals, and control of blood sugar levels overnight.1

The disadvantages in using the regimen include having to take four injections a day, adapting to a routine, having trouble taking the injections, and keeping a supply of insulin with you.1

 

References:

(1) Biggers, A. How to Manage Diabetes With Basal-Bolus Insulin Therapy. Medical News Today. Available from: https://www.medicalnewstoday.com/articles/316616.php. Accessed October 23, 2018.

(2) Jackson B, Grubbs L. Basal-bolus insulin therapy and glycemic control in adult patients with type 2 diabetes mellitus: a review of the literature. J Am Assoc Nurse Pract. 2014;26(6):348-52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24170333. Accessed October 23, 2018.

(3) Vinagre I, Sánchez-hernández J, Sánchez-quesada JL, María MÁ, De leiva A, Pérez A. Switching to basal-bolus insulin therapy is effective and safe in long-term type 2 diabetes patients inadequately controlled with other insulin regimens. Endocrinol Nutr. 2013;60(5):249-53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23523346. Accessed October 23, 2018.

(4) Magaji V, Johnston JM. Inpatient management of patients of hyperglycemia and diabetes. J Clin Diabetes. 2011;29(6): 3-9. Available from:
http://www.diabetesed.net/page/_files/Inpt-Management-of-Hyper-Magaji-2011.pdf Accessed October 23, 2018.

 

Artur Dzhurinskiy
18 July, 2019

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My name is Artur Dzhurinskiy and I graduated from St. Louis College of Pharmacy in 2014 with a doctor of pharmacy degree. Through my academics I gained valuable experience learning about various medications that are...read more:

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