Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-20

GETTING STARTED WITH BASAL-BOLUS INSULIN THERAPY

Select a therapeut ic regimen Ensuring that the individual is well prepared to begin BBIT will minimize adjustment issues and foster the successful use of IT whether by BBI or pump therapy. Using a collaborative approach, the DHC team works with the patient and his or her family to discuss: • Willingness to monitor at least four times a day or use a sensor. • Willingness and ability to use some form of carbohydrate counting or carbohydrate consistency and commit to using during the initial implementation phase at a minimum. Nutrition counselling is required with a change in insulin therapy, since the goal is to design the insulin plan to match food intake. A carbohydrate goal for each meal and snacks needs to be selected and used to establish a baseline dose. • A BBI regimen o Which delivery method: basal bolus injection therapy or CSII? • Which insulin: basal and bolus • Plans for change • Identify goals Use of educational theory should guide clinicians in this process (42). The options will depend on the patient’s needs, type of diabetes and preferences and financial resources. The following pages are examples of patient handouts that outline options for insulin replacement that should be thoroughly discussed with the patient before a decision is made. Please note that the drawings below are an approximation of insulin action. They also generally depict plans for people who typically eat three meals per day without between-meal or bedtime snacks. If carbohydrate-containing snacks are added to an insulin plan that uses rapid insulin, a dose of insulin will also be needed for the snack, regardless of whether BBI or pump therapy is used. If short-acting insulin is used, some snacks without a bolus may be possible due to the longer peak of these insulins. However, in general, rapid- or short-acting insulin will have to be taken each time a significant amount of carbohydrate-containing food or fluid is ingested for BBI to be successful.