Basal-Bolus Insulin Therapy

Type 1 and Type 2 diabetes impede the body’s ability to produce and use insulin, the hormone that allows the cells to turn blood sugar into energy. Basal bolus-Insulin therapy is one way to treat diabetes.


Basal-bolus insulin therapy (BBIT) is a common treatment option that can be used to manage both Type 1 and Type 2 diabetes. It’s worth noting that this type of therapy is gradually losing its popularity thanks to more and more doctors and patients turning to advanced insulin pump options. In fact, about 30-40 percent of people with Type 1 diabetes have made the switch to an insulin pump, thereby avoiding the need for daily insulin injections. 

Nevertheless, many people living with diabetes still rely on the basal-bolus method and it’s wise to understand how this flexible and effective insulin delivery program works.

Insulin Production in Those Without Diabetes

In a healthy person who does not have diabetes, the pancreas produces insulin to control blood sugar at a rate based on the body’s needs. For instance, more insulin is released during the period following a meal in order to process the added blood sugar that eating produces. Conversely, less insulin is produced when the body is at rest or sleeping. In most people, this process is natural regulated by the body, adjusting insulin as needed so levels remain in the healthy range and don’t change dramatically based on what they eat or any other factors. This isn’t the case for those with diabetes.


Basal-Bolus Therapy Mimics Normal Insulin Production

Someone with diabetes can’t rely on the body to regulate its own insulin production. Therefore, blood sugar can’t be consistently controlled without some help. Enter basal-bolus insulin therapy. BBIT is designed to mimic the way a healthy person would produce insulin throughout the day using two different types of insulin injections - basal and bolus.


Basal Insulin

Basal insulin, often referred to as “background insulin”, is injected by syringe or insulin pen once or twice a day in most cases. Think of basal insulin as your insulin foundation, ensuring that your body maintains a steady level of the hormone throughout the day – even though as someone living with diabetes your body could not do so on its own. Basal insulin is available in three main types - intermediate acting, long-acting and ultra-long-acting. Some people may need to take a mix of these types each day based on their individual doctor’s recommendation. Regardless, basal insulin injections are used to mimic the set amount of insulin a healthy pancreas would produce throughout the day. It’s gradually absorbed and ensures blood sugar remains consistent through periods of fasting and resting.

Bolus Insulin

Every time we eat, it causes our blood sugar to naturally rise. Bolus insulin is taken, also by syringe or insulin pen, at mealtimes to keep blood sugar levels in check and counteract that expected spike after a meal. Some people take a bolus dose before eating and others take it immediately following a meal. Your doctor will determine which works best for you. Think of bolus insulin as the short-term insulin boost your body needs when more glucose is added to the bloodstream. Unlike basal insulin that is gradually absorbed during the day, bolus insulin needs to act quickly. There are two primary types of bolus insulin - rapid-acting and short-acting. Rapid acting insulin starts to work in as little as 15 minutes and only remains in the bloodstream for 3-5 hours. Short-acting insulin kicks in after about 30 minutes but remains in the bloodstream for up to 12 hours. Again, which is right for you depends on your individual diabetes treatment plan as directed by your endocrinologist or diabetes physician.

The Advantages of Basal-Bolus Insulin Therapy

The primary advantage of a basal-bolus diabetes treatment plan is that it can be extremely beneficial in keeping blood glucose levels in the normal range over the long term. By combining a foundation of basal insulin with fast-acting bolus insulin at mealtimes, you’re effectively copying how your body and pancreas would normally produce insulin if you did not have diabetes.

Another big advantage is flexibility. Bolus insulin is taken at mealtimes and can be adjusted based on when you eat, how many carbs you consume, and how much food you eat at any given meal.

The basal-bolus method is also beneficial if you’re having difficulty maintaining consistent blood sugar levels, particularly if you’re experiencing lows during the overnight hours when you’re sleeping. It can also be helpful for those who work odd hours or do not have a set daily routine, as the basal dose will maintain insulin levels and bolus doses can be adjusted as needed.


Challenges of Basal-Bolus Insulin Therapy

There are some considerations to be aware of when considering BBIT. First and foremost, this type of diabetes management will require multiple insulin injections every day by syringe or insulin pen. After all, you’ll be taking bolus doses at every meal and combined with basal doses this can add up to six or more injections each day. For some people, this many injections can be problematic, particularly children who will need to feel comfortable giving themselves injections or having a caregiver give them injections during lunchtime at school.

Another challenge of basal-bolus therapy is that it requires you to test your blood sugar more often each day - usually six times at a bare minimum. Many people use a continuous glucose monitoring device (CGM) to make this much easier. For others, it means more finger pricks and diabetic test strips to track blood sugar using a glucose meter. Tracking blood sugar is important because hypoglycemia, or low blood sugar, is a relatively common occurrence among people using the basil-bolus method. In fact, it’s recommended that you keep glucose tabs or some chewable candy handy just in case you experience a drop in blood sugar.

Finally, you’ll also have to play extremely close attention to what you eat. This should be nothing new for diabetics but it’s very important when using the basal-bolus method because what you eat will impact your bolus dose. You’ll need to learn to accurately calculate carbohydrate intake at every meal in order to properly adjust and administer the right amount of bolus insulin.


Is Basal-Bolus Insulin Therapy Right for Me?

If you have Type 1 diabetes, the basal-bolus method is the best way to manage your diabetes, provided you’re not already using an insulin pump. If you have Type 2 diabetes, it really depends on your specific condition. If you’re experiencing significant rises in blood sugar after meals or need a flexible insulin treatment plan to fit your busy lifestyle, it certainly might be the answer. BBIT does require some additional work and commitment on your part, however, the flexibility and added blood sugar control gained from it can often dramatically improve your quality of life and overall health. For most people, this is worth a little extra effort.

Step 1: Talk to Your Diabetes Physician

As with any diabetes treatment option, the only way to see if a basal-bolus program is right for you is by speaking with your diabetes physician and care team. If so, they’ll help you create a program that includes the right types of insulin, the right doses, and the right scheduling. 


We hope you found this blog interesting and informative. At Diabetic Warehouse, we understand the challenges of living with diabetes and know the best thing you can do to stay healthy once diagnosed is adhere to your doctor-prescribed testing and treatment program.

To help, we offer a complete selection of diabetic supplies and equipment from leading manufacturers, including FreeStyle, Dexcom, Accu-Chek, TRUEmetrix, One Touch, Contour Next, BD Ultra-Fine and many others at savings of up to 65%. Visit us online to shop for glucose meters, test strips, lancets, insulin syringes, pen needles, infusion sets, continuous glucose monitoring systems (CGM), ketone test strips, blood pressure monitors, and all your diabetic accessories.

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