A guide to basal-bolus insulin therapy
There is no 'one-size-fits-all' insulin therapy suitable for all individuals with diabetes. Cases range in severity from insulin resistance to total beta cell failure. Basal-bolus insulin therapy, which combines different insulin, offers the option of tailoring the insulin types and amounts to the individual patient's needs.
Basal-bolus insulin therapy explained
Basal and bolus insulin handle two different types of glucose present in the body.
- Basal insulin manages the baseline glucose that the liver produces continuously throughout the day.
- Bolus insulin targets the bursts of glucose that the body experiences after eating, especially after eating a meal with a large amount of carbohydrates or sugars.
These eating-related glucose bursts require a fast-acting insulin, and bolus insulin is up to the task.
Basal-bolus insulin therapy, also called intensive insulin therapy, delivers both types of insulin in a dosage designed to compensate for the diabetic's lack of insulin or insensitivity to the body's own insulin. Since the healthcare practitioner can determine exactly how much basal and bolus insulin a patient needs, basal-bolus therapy is a flexible and effective therapy option. Patients generally monitor blood glucose levels and inject the insulin four times a day -- just once for the long-acting basal insulin, and an injection at every meal for the fast-acting bolus insulin. Some patients use a basal-bolus insulin pump, which delivers rapid-acting insulin as needed throughout the day.
The basal-bolus insulin therapy in practice
Basal-bolus insulin therapy offers a powerful, customizable tool for managing blood sugar levels. Since patients maintain tight control over their glucose levels, they are able to eat a variety of foods without experiencing glycemic excursions. Patients take an active role in adjusting their basal and bolus insulin dosages as necessary, given their dietary and lifestyle choices. Important practices for an effective basal-bolus therapy regimen include the following:
- Testing basal insulin levels
- Counting carbohydrates
- Planning for exercise or physical activity
Basal-bolus therapy is especially useful for patients with type 1 diabetes. Type 1 diabetes involves a deficiency of insulin due to the destruction of insulin-producing beta cells in the pancreas. Since the basal-bolus regimen is designed to mimic the function of a healthy pancreas, this therapy is a perfect fit for type 1 diabetics.
Individuals with type 2 diabetes, who have trouble keeping their blood glucose levels in check through other means, can also benefit from basal-bolus therapy. Type 2 patients often suffer from insulin resistance as well as insulin deficiency, however, so the regimen may need to be adjusted to account for the cell's inability to respond appropriately to the administered insulin.
For patients willing to take an active role in their treatment, basal-bolus insulin therapy offers a flexible solution for keeping blood glucose levels in control throughout the day.
American Diabetes Association, "Living with Diabetes"
Diabetes Daily, "Basal/Bolus Therapy"
Gallen, Ian "The Evolution of Insulin Treatment in Type 1 Diabetes: The Advent of Analogues", British Jouranl of Diabetes & Vascular Disease, 2004