Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-17

Therefore, mimicking this pattern means having the following: • A relatively low insu lin level during periods of fasting. • A rapid increase in insulin levels postprandially, in an amount that varies according to food absorption. o First-phase insulin secretion over two to five minutes. o Second-phase insulin secretion over five to 52 minutes, depending on the glycemic index of food ingested and absorption factors. • A decrease in insulin levels when exercising or fasting. • An increased amount of insulin in response to counterregulatory hormone production. BBIT seeks to mimic this pattern, requiring the individual to think and act like a pancreas to match the insulin to glucose needs. This remains a significant challenge. Despite advances in technology and tools, many barriers remain, including insulin that absorbs imperfectly; a BG feedback system that operates intermittently or imprecisely; inability to adapt immediately to changing needs or stress; variable carbohydrate absorption and/or glycemic index response (41).