Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-24

insulin. o Glargine U300 and detemir have been associated with small weight loss, no weight change or less weight gain compared to other basal insulins. • Limitations o The limitations are the same as BBI four injections/day, rapid/short and intermediate- acting. o Basal analogues are more expensive than intermediate-acting insulin. o Glargine is available in both vial and cartridge; detemir, glargine U300, degludec is available in a pen cartridge only. o Both product monographs recommend against mixing basal analogues with other insulins. o May require bolus with snacks between meals.

Figure 5. Continuous subcutaneous insulin infusion (CSII)

• Type o Rapid (aspart, lispro or apidra) or Humulin R. Analogues are preferred. o Fiasp not currently approved for pump use in North America. • Timing o Rapid-acting insulin is given on a continual basis, duplicating basal insulin secretion. The preprandial “bolus” insulin dose is dependent on the BG level, anticipated carbohydrate content of meal and activity level, as with BBI regimens.