Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-21

Figure 2. Learn to mimic the pancreas

Individuals who decide to use a BBI approach accept that a fixed dose of insulin does not accommodate variations in lifestyle or metabolic requirements from moment to moment or day to day. Patients using premixed insulins cannot make the adjustments required for IT.

BBI regimens are based on the premise that, when determining insulin dose for injection or infusion, one must take into account the following: 1. Current BG level. 2. Anticipated insulin needs based on the amount/glycemic index of carbohydrate to be ingested. 3. Amount/intensity/type of activity anticipated or completed. Insulin regimens must meet the body’s needs for basal and bolus insulin requirements (Figure 2); ideally, BBI involves four or more daily insulin injections or an insulin pump. See Figures 3, 4 and 5 for examples of different BBI options, along with potential benefits and limitations. These regimens require regular involvement of health-care professionals for SME, at least initially, until baseline doses are established.