Building Competency in Diabetes Education THE ESSENTIALS

TREATMENT MODALITIES: PHARMACOLOGICAL THERAPIES | 6-93

Basal-bolus insulin - Multiple daily injection therapy Basal-bolus insulin therapy mimics the normal physiological function of beta cells more closely than other insulin regimens. Research has shown that people with type 1 diabetes, type 2 diabetes and diabetes-in-pregnancy can achieve excellent glycemic control with a basal-bolus insulin regimen (see Chapter 12: Basal-Bolus Insulin Therapy).

Figure 6. Basal-bolus insulin regimen: 4 to 5 injections/day

• Insulin type and timing:

o Rapid-acting insulin analogue (short-acting) insulin prior to breakfast, lunch and dinner. o Basal insulin: ▪ Glargine U-300 and degludec U-100/U-200 can be dosed in the morning or evening. ▪ Glargine U-100 or detemir (intermediate-acting insulin) once-daily in evening. Some people may benefit from twice-daily injections: 30%-50% of total basal insulin taken at breakfast or lunch and 50%- 70% taken in evening.

• Dosage :

o Calculate the total daily dose (TDD): 0.3 to 0.5 units/kg or the sum of the individual’s current insulin doses. Distribute TDD as follows: