Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-53

CSII examples:

Rapid-acting insulin 8 units at breakfast, 5 units lunch and 8 units at dinner; Basal analogue 20 units at bedtime TDD: 8 + 5 + 8 + 20 = 41 Reduce by 25% (TDD: 41 – 10.25 = 31 units) New TDD = 31 units

Meeting basal requirements Typically, 40 to 50% of the TDD is used for the starting basal dose (72,7480). BBI calculations for people with type 2 diabetes in the 2018 Guidelines suggest 40% of the TDD as basal insulin coverage (120). Example using 40% of TDD to meet basal needs: Once-daily basal TDD = 60 units Basal: 60 x 0.4 = 24 units Twice-daily basal TDD = 60 units Basal: 60 x 0.4 = 24 units

24 x 0.7 = 16.8 units 24 x 0.3 = 7.2 units Take basal 17 units at 10:00 PM or in the evening and 7 units at breakfast or lunch (73).

Take basal 24 units at 10:00 PM or evening.

Typically, 50% of the TDD is used to calculate basal requirements. A single basal rate is used at CSII initiation, and maintained until all previously injected basal insulin (NPH or LAA) is eliminated. Then multiple basal rates per day can be started. Basal doses are programmed at variable times to meet the varying needs for basal insulin during the day. Almost all individuals need more than one basal rate, often more; the lowest rate is usually during the early morning hours, with an increased rate during the dawn hours (3:00 AM to 7:00 AM/ 8:00 AM) to match the dawn phenomenon.