Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-23

morning or at lunch usually helps. o Intermediate-acting insulin requires re-suspension, has a more pronounced peak, has a more variable insulin action and increased risk of hypoglycemia when compared to basal analogues.

Figure 4. BBI using 4 or 5 injections/day: Rapid/short and long-acting insulin analogue

• Type and timing o Rapid/short insulin prior to breakfast, lunch and dinner. o Glargine or detemir insulin once daily in the evening. Some people may benefit from twice- daily injections at breakfast or lunch and evening. o or glargine U300 or degludec U100/U200 once daily • Benefits o The benefits are the same as BBI four injections/day, rapid/short and intermediate- acting. o Glargine and detemir have less nocturnal hypoglycemia compared to intermediate- acting. o Glargine U300 and degludec U100 or U200 can be dosed in the morning or evening and have less nocturnal hypoglycemia than glargine and detemir. o This may be a good basal plan for some patients, since basal analogues relatively peak less, have less variable absorption and last longer compared to intermediate-acting