Keeping your blood glucose levels in check starts with your basal-bolus insulin plan. This plan consists of using short-acting insulin to prevent a rise in blood glucose after eating meals and a longer-acting insulin to keep blood glucose steady during periods of fasting, such as sleeping.
This plan requires a number of injections throughout the day in order to mimic the way a non-diabetic person’s body receives insulin.
According to the American Diabetes Association (ADA), there are two types of bolus insulin: rapid-acting insulin and short-acting insulin.
Rapid-acting insulin is taken at mealtime and starts working in 15 minutes or less. It remains in the bloodstream up to 4 hours.
Short-acting or regular insulin is also taken at mealtime, but it begins working about 30 minutes after the injection and stays in the bloodstream from 4 to 6 hours.
Along with these two types of bolus insulin, there are two kinds of bolus injections: carbohydrate bolus and correction bolus.
With a carbohydrate bolus, short-acting insulin is taken before you eat any meal or snack to match the amount of carbohydrates consumed and to keep blood glucose under control after eating. An endocrinologist will decide the best insulin-to-carbohydrate ratio for measuring units.
With a correction bolus, blood glucose should be monitored several times a day, and if the level is too high, then short-acting insulin should be used to correct it.
Basal insulin is taken once or twice a day, usually around dinnertime or bedtime. There are two types of basal insulin: intermediate, which works up to 16 hours after injection, and long acting, which works up to 24 hours after injection.
While we sleep, the liver continuously secretes glucose into the bloodstream. For those with diabetes, whose pancreas produces little to no insulin, basal insulin is crucial for keeping these blood glucose levels under control and allowing the blood cells to use the glucose for energy.
The Benefits of a Basal-Bolus Plan
A basal-bolus plan for managing diabetes goes a long way in keeping blood glucose within a normal range. This plan will allow for a more flexible lifestyle, especially since a balance can be made between the timing of meals and the amount of food eaten.
This regimen can also be useful in these situations:
- If you’re having trouble with low blood glucose levels during the night.
- If you desire to travel across time zones.
- If you work odd shifts or hours for your job.
- If you enjoy sleeping in or don’t have a routine sleeping schedule.
But in order to get the most benefits from a basal-bolus plan, you must remain vigilant by following the necessary steps, including:
- Checking your blood sugar at least four to six times each day.
- Using your short-acting insulin with every meal and snack. This can sometimes mean taking up to six injections a day, depending on the amount of carbohydrates in your food.
- Keeping a journal or log of your food intake and blood glucose readings. This can be especially helpful for you and your physician if you’ve been having a difficult time keeping your levels in the normal range.
- Consulting with a diabetes educator or dietitian if you’re having a hard time developing a healthy eating plan.
- Understanding how to calculate carbohydrates. There are many books and websites available that include the carbohydrate content in regular foods and fast foods. Keep a copy in your wallet and car for those times when you eat out and are unsure of what to order.
- Learning how to adjust your insulin to counteract any changes in your activity level.
- Always keep sources of sugar on you, such as chewable candies or glucose tablets, to treat low sugar should it occur. Hypoglycemia is more common with basal-bolus treatment.
If you feel like your basal-bolus regimen isn’t working for you, then contact your endocrinologist. Discuss your schedule, day-to-day habits, and anything that could be helpful in deciding which insulin therapy is best for your needs.
While a basal-bolus approach might involve more work on your part, the quality of life and freedom gained from it are, in many ways, worth the extra effort.