Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-4

Activity/exercise • List general principles related to exercise/activity and intensive therapy. • Discuss methods of estimating carbohydrate requirements for exercise/activity. • Outline recommendations for carbohydrate intake pre-, inter- and/or post-exercise/activity. • Describe appropriate insulin adjustment for activity.

Conventional insulin therapy vs. basal-bolus insulin therapy Convent ional insulin therapy

Historically, conventional insulin therapy included the use of either a premixed insulin or self- mixing intermediate-acting insulin with short-acting insulin which involved two injections a day. Typically, it was given before breakfast and dinner. It used to be recommended for people with diabetes before the concept of “self-management” evolved and the results of the Diabetes Control and Complications Trial (DCCT) were published. Conventional therapy is now referred to as BID premixed insulin therapy which includes the use of premixed insulin, premixed analogues or self-mixing of rapid/short and intermediate or separate injections of rapid/short insulins and long-acting insulins. Diabetes educators will still see the term conventional therapy used in the literature. For people with type 1 diabetes, conventional therapy or premixed insulin is not the standard of care and is used only in certain circumstances, since tight blood glucose (BG) control is difficult to achieve with this regimen. Premixed insulin therapy, however, may be an appropriate approach for people with stable type 2 diabetes who have a consistent food and activity schedule. Conventional management involves the use of a fixed amount of insulin at prescribed times and consistent food consumption and activity every day. This approach does not take into account the changing requirements for insulin based on day-to-day variations in personal activity, degree of stress and food intake. It is also an approach that demands less personal involvement than basal-bolus insulin therapy.