Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-27

thirds of daily total intermediate- or long-acting insulin and two-thirds of daily total rapid/short-acting insulin is given pre-breakfast. The remaining one-third rapid/short-acting is given at supper, and the remaining one-third intermediate- or long-acting basal analogue is given at bedtime. Example: Total daily dose is 60 units. • Total intermediate- or long-acting insulin is two-thirds of 60 = 40 units. • Total rapid/short-acting insulin is one-third of 60 = 20 units. Pre-breakfast dose of intermediate- or long-acting is two-thirds of 40 units (26 units) and two- thirds of the rapid/short-acting 20 units (13 units). The remaining one-third of 20 units rapid/short-acting is given at supper (7 units). The remaining one-third of 40 units of intermediate- or long-acting is given at bedtime (13 units). • Benefits o Intermediate- or long-acting basal analogue insulin given at bedtime has the benefit of reducing pre-breakfast hyperglycemia without increasing the risk of overnight hypoglycemia. o Rapid/short-acting insulin can be altered to accommodate changes in food and activity. o Insulin pens can be used at dinner and at bedtime, since insulin is not being mixed. • Limitations o There is a lack of lunchtime flexibility. o This regimen usually requires an afternoon snack if NPH/N is used. o If basal analogues are used: ▪ Separate injections are needed if syringes are used. ▪ Lunch coverage may not be adequate depending on the amount of carbohydrate consumed. ▪ BG control is more difficult during the day. Once the BBI injection regimen has been decided, the bolus and basal insulin will need to be discussed.