By Adam Garcia
Even though I am not a Type 1 that has an insulin pump, I have decided to discuss basal-bolus therapy in diabetic dictionary today. As you may already know insulin controls the level of glucose in your blood. Your body needs insulin throughout the day and night. In people without diabetes, the pancreas provides a basal, or background level of insulin. After a meal blood sugar rises and more insulin is needed. This is called a ‘bolus’.
Basal or background insulin
Basal, or background insulin, is longer-acting insulin (usually cloudy). Each night you will take an injection of longer-acting insulin. (Your doctor may prescribe this injection twice daily.) This insulin will help to control your blood sugar level while you sleep and during the next day. You do not need to eat after this injection unless your glucose level is low.
Bolus insulin
Bolus insulin (clear) is short-acting insulin taken three times a day at each mealtime – breakfast, lunch, dinner. It can be taken immediately before, during, or after your meal. It starts to work straight away and usually lasts for about five hours. The amount of insulin needed can vary. If you plan a smaller meal, then take less insulin. Likewise, if your meal is large, then take more insulin.
Your healthcare team will guide you. Basal bolus therapy allows for flexibility of timing and meal size. You do not have to eat your meals at the same time each day. If you are eating out, you can inject as soon as your meal is ready for you. If your appetite is unpredictable you can inject a dose of insulin immediately after the meal based on what you managed to eat.
Points to remember
- In the beginning test your blood sugars four times a day: before meals and at bedtime.
- Only eat large meals occasionally – people with diabetes can become overweight, just like everyone else.
- Try to avoid snacks between meals. If you need something to prevent a ‘hypo’ (low blood sugar), try a piece of fruit, a whole meal scone or a cereal bar.
- Eat regularly if possible and try not to miss meals.
- If you miss a meal, take your next bolus dose and meal as soon as possible.
Remember, if you are ill:
- Do not stop taking your insulin.
- Drink plenty of fluids
- If you are unable to eat normally, and your blood sugar levels fall, try glucose drinks.
If you need more advice, contact your healthcare team. If you have other terms for Diabetic Dictionary that you do not understand email us or leave a comment or question below.
