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 when you’re sleeping.
This plan may require a number of injections throughout the day in order to mimic the way a non-diabetic person’s body receives insulin, unless you’re on pump therapy or using intermediate-acting insulin instead of long-acting insulin.
There are two types of bolus insulin: rapid-acting insulin and short-acting insulin.
Rapid-acting insulin is taken at mealtimes and starts working in 15 minutes or less. It peaks in 30 minutes to 3 hours, and remains in the bloodstream for up to 3 to 5 hours. Short-acting or regular insulin is also taken at mealtimes, but it begins working about 30 minutes after the injection, peaks in 2 to 5 hours and stays in the bloodstream for up to 12 hours.
Along with these two types of bolus insulin, if you’re on a flexible insulin schedule, you need to calculate how much bolus insulin you need. You’ll need insulin to cover carbohydrate intake as well as insulin to “correct” your blood sugar.
People on a flexible dosing schedule use carbohydrate counting to determine how much insulin they need to cover the carbohydrate content of their meals. This means you would take a certain number of insulin units per a certain amount of carbohydrate. For example, if you need 1 unit of insulin to cover 15 grams of carbohydrate, then you would take 3 units of insulin when eating 45 grams of carbohydrate.
Along with this insulin, you may need to add or subtract a “correction amount.” If your glucose level is a certain amount higher or lower than your target glucose when you start a meal, you may take more or less bolus insulin to help correct this. For example, if your blood sugar is 100 mg/dL over your set threshold, and your correction factor is 1 unit per 50 mg/dL, you would add 2 units of your bolus insulin to your mealtime dose. A doctor or endocrinologist can help you decide the best insulin-to-carbohydrate ratio and correction factor.
Basal insulin is taken once or twice a day, usually around dinnertime or bedtime. There are two types of basal insulin: intermediate (for example, Humulin N), which begins working 90 minutes to 4 hours after injection, peaks in 4-12 hours, and works up to 24 hours after injection, and long acting (for example, Toujeo), which begins working within 45 minutes to 4 hours, does not peak, and works up to 24 hours after injection.
While we sleep and fast between meals, the liver continuously secretes glucose into the bloodstream. If you have diabetes and your 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 using rapid-acting and long-acting insulin for managing diabetes goes a long way in keeping your blood glucose within a normal range. This plan will allow for a more flexible lifestyle, especially since you can find a balance 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’re planning 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.
In order to get the most benefits from this specific basal-bolus plan, you must be vigilant about 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. This can sometimes mean taking up to six injections a day.
- Keeping a journal or log of your food intake and blood glucose readings, along with your insulin dose amounts. 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 keeping sources of sugar on you, such as chewable candies or glucose tablets, to treat low blood sugar should it occur. Hypoglycemia is more common with a basal-bolus treatment plan.
If you feel like your basal-bolus regimen isn’t working for you, then contact your doctor or 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 a bit more work on your part, the quality of life and freedom gained from it are, in many ways, worth the extra effort.