Basal-bolus therapy

Hermansen K, Madsbad S, Perrild H, Kristensen A, Axelsen M. Comparison of the soluble basal insulin analogue insulin detemir with NPH insulin a randomized open crossover trial in type 1 diabetic subjects on basal-bolus therapy. Diabetes Care 2001 24(2) 296-301. 

Albright ES, Desmond R, Bell DSH. Efficacy of conversion from bedtime NPH insulin injection to once- or twice-daily injections of insulin glargine in type 1 diabetic patients using basal/bolus therapy. Diabetes Care 2004 27 632-3. 

Type 1 treatment necessitates Insulin therapy. Currently, the basal-bolus Insulin therapy or pump therapy in motivated individuals often leads to successful glycemic outcomes. Basal-bolus therapy often includesa basal insulin forfasting and postabsorptive control, and rapid acting bolus insulin for mealtime coverage. Therapeutically, use of basal-bolus therapy in type 2 DM is increasing. 

Hermansen K, Fontaine P, Kukolja KK et al. Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal-bolus therapy for patients with type 1 diabetes. Diabetologia. 2004 47(4) 622-629. 

De Leeuw I, Vague P, Selam JL, Skeie S, Lang H, Draeger E, Elte JW. Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin. Diabetes Obes Metab 2005 7(l) 73-82. 

Treating Subjects with Type 2 Diabetes with Multiple Injections (Basal-Bolus Therapy)... 

Herz M, Arora V, Sun B, Ferguson SC, Bolli GB, Frier BM. Basal-bolus insulin therapy in Type 1 diabetes comparative study of pre-meal administration of a fixed mixture of insulin lispro (50%) and neutral protamine lispro (50%) with human soluble insulin. Diabet Med 2002 19(ll) 917-23. 

In conventional intensified insulin therapy (MDI) using the basal-bolus approach with MDI, continuous basal insulin supply is obtained by once- or twice-daily subcutaneous injections of longer-acting preparations, supplemented by mealtime injections of more rapid-acting formulations. 

Currently, the most advanced form of insulin therapy is the insulin pump, also referred to as continuous subcutaneous insulin infusion (CSII). Using the short- or rapid-acting insulins only, these pumps are programmed to provide a slow release of small amounts of insulin as the basal portion of therapy, and then larger bolus doses are injected by the patient to account for the consumption of food. 

Insulin pump therapy consists of a programmable infusion device that allows for basal infusion of insulin 24 hours daily, as well as bolus administration following meals. As seen in Fig. 40-3, an insulin pump consists of a programmable infusion device with an insulin reservoir. This pump is attached to an infusion set with a small needle that is inserted in subcutaneous tissue in the patient s abdomen, thigh, or arm. Most patients prefer insertion in abdominal tissue because this site provides optimal insulin absorption. Patients should avoid insertion sites along belt lines or in other areas where clothing may cause undue irritation. Infusion sets should be changed every 2 to 3 days to reduce the possibility of infection. 

CONTINUOUS SUBCUTANEOUS INSULIN INFUSION A number of pumps are available for continuous subcutaneous insulin infusion (CSII) therapy. CSII, or pump, therapy is not suitable for all patients because it demands considerable attention, especially during the initial phases of treatment. For patients interested in intensive insulin therapy, a pump may be an attractive alternative to several daily injections. Most pumps provide a constant basal infusion of insulin and have the option of different infusion rates during the day and night to help avoid the dawn phenomenon and bolus injections that are programmed according to the size and nature of a meal. 

Insulin pump therapy started in UK in 1976. Insulin pnmps deliver a continnons basal insulin infnsion (CSII) and patient-activated bolus doses at meal times. The pump is attached to the patients by an infusion set consisting of long flexible tubing with a needle or catheter on the end and is inserted subcnta-neously in the patient. In two meta-analysis CSII was compared with conventional insulin treatment... 

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