Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-11

preprandial/pre-activity testing. This allows for greater freedom of lifestyle and daily schedule.

Increased feeling of general well-being Since BG levels are similar to those without diabetes, decreased energy and other symptoms associated with elevated BG can be markedly improved. The sense that one has some control over the disease and over lifestyle choices also contributes to a sense of well-being and self- efficacy. Lowered maternal and fetal morbidity and/or mortality during pregnancy Although insulin therapy should be individualized in order to achieve glycemic targets, BBIT with either multiple daily injections (MDI) or CSII is recommended for women with either type 1 or 2 diabetes prior to conceiving (30). To decrease the risk of spontaneous abortion, congenital anomalies, preeclampsia and progression of retinopathy in pregnancy, an A1C of ≤7% is the goal preconception and, once pregnant, aim for the following glucose targets: fasting glucose of <5.3 mmol/L, 1-hour postprandial <7.8 mmol/L or 2-hour postprandial <6.7 mmol/L (30). For women with gestational diabetes who do not achieve glycemic targets with nutritional therapy, insulin is recommended. Fetal and maternal morbidities have been reduced when insulin is used to achieve glycemic control (28). There are a number of different insulin protocols, but BBI is the most effective regimen (30). More detailed information on gestational diabetes mellitus can be found in Chapter 10: Gestational Diabetes Mellitus. For preconception care in type 1 and type 2 and for more information regarding pregnancy in type 1 and type 2 diabetes, please refer to the 2018 Guidelines, “Pregnancy and Diabetes” chapter (30).

Increased ability to rapidly correct high BG High BG can be corrected quickly with the use of supplements using a variable insulin dose scale or correction factor and meal boluses.

Potent ial treatment strategy to modify natural history of type 2 diabetes There is growing evidence to suggest short-term (two to three weeks) intensive insulin therapy used soon after diagnosis can improve glycemic control that results in normal glucose levels for one to two years, without the use of antihyperglycemic agents (23).