Type 1 Diabetes? The Basal Bolus Regimen Explained For Optimal Control

Type 1 Diabetes? The Basal Bolus Regimen Explained For Optimal Control
Type 1 diabetes is an autoimmune disease usually treated with a basal bolus insulin regimen. It usually manifests in childhood but can be diagnosed at any age. This means the body’s immune system targets the insulin producing pancreas cells and marks them for destruction. This leaves the sufferer unable to produce any insulin of their own and thus cannot control their blood glucose levels. Blood glucose if left untreated will rise uncontrollably resulting in death. Why this happens, nobody knows. There are several theories including a stress or viral trigger but the answer remains elusive. Type 1 diabetes is a lifelong condition. The treatment for this is to take insulin several times a day.

Insulin

The problem with producing none of your own insulin is two primary daily factors act to push up your glucose levels. First, your liver consistency releases stored glucose into the blood and therefore increases glucose levels. The second cause is from food. Carbohydrates are converted into glucose and also increase glucose levels. Stress and illness can also push up glucose levels as the stress hormones trigger a release of glucose. Without insulin, glucose levels rise unchallenged. Therefore, insulin needs to be injected to combat all the sources of glucose entering your system to keep them within normal parameters.

The basal bolus regimen

In order to control the factors conspiring to increase your glucose levels you must inject insulin. There a few insulins regimens which can address but one is undoubtably more effective than all others. This is the basal bolus regimen. Before recent times people with type 1 diabetes did not have the benefit of a basal bolus regimen. They had to rely on the best available insulin available at the time which historically was twice a day insulin. We still sometimes see this in practice, particularly with patients unable to inject several times a day, but it is seldom optimal management. Instead, the basal bolus regimen requires two different types of insulin. The first type known as your basal insulin works in the background. We call this your background or slow releasing insulin for this reason. This insulin generally works over 18-36 hours (ideally 24 hours as a minimum but not all do) and drips a small amount of insulin into your system all day. This helps to control the small amounts of glucose dripping into your system from your liver and already circulating in your blood. The second type of insulin is your bolus insulin. This insulin is given with any carbohydrate containing food because it is rapid acting. Generally this will be given with meals and snacks assuming there is a sufficient level of carbohydrate. If you don’t know much about carbohydrates, read this.  Between them both they control the main causes of increasing blood glucose levels.

Putting it all together

Of course you need to know how much insulin to take. Your healthcare team will help you calculate this. The basal insulin should keep you steady throughout the day if you did not eat (so no food effects it) and overnight. If you see rapid swings from low to high or high to low it without they influence of food or any bolus insulin, it likely means the basal insulin needs adjusting. If you notice this it is worth speaking with your healthcare team to consider making adjustments. As time passes you may feel confident to adjust this yourself. The basal insulin is taken once or twice daily. My personal preference is to use basal insulins which are used only once daily because it is less injections. However, you doctor may have a good reason for leaving you on a twice daily. Sometimes this can be a bit more flexible and helps if you suffer with variable glucose levels between night and morning. The bolus insulin is best used when incorporated alongside carbohydrate counting. I have talked about this previously here.  Basically, carbohydrate counting revolves around self adjusting your insulin based on how much carbohydrate you eat. This is worked out using a ratio of bolus insulin to grams of carbohydrate eaten. For example, a ratio of 1unit:10g and you ate 50g of carbs, means ou would need to take 5 units.

Summary

If you manage to get this right, you tend to find glucose levels improve greatly. We also find people taking high doses of insulin but not following any particular method of insulin adjustment reduce their total daily dose. This education should be offered to everyone with type 1 diabetes. If you haven’t been offered this I would suggest speaking with your GP regarding a referral.

Need more help

If you need more support we offer a range of 1:1 consultancy services and online programmes focused on helping you improve your glucose control and health for the long term. These include our type 2 diabetes recovery programme, type 1 glucose stability programme and winning weight loss programme. Go to the pages using the links above or in the headers or get in touch if you have questions.