BasalBolus

Basal-bolus therapy is an intensive insulin treatment regimen used to manage diabetes by closely mimicking the body's natural pattern of insulin secretion. It combines a basal (background) insulin delivered to maintain steady blood glucose levels between meals and overnight with bolus (mealtime) insulin given to cover carbohydrates consumed at meals and to correct hyperglycemia.

Basal insulin is long-acting and provides a steady, low level of insulin over 24 hours. Common basal options include long-acting insulins such as glargine, detemir, and degludec. Bolus insulin is rapid-acting and is taken at mealtimes or for corrections; rapid-acting analogs such as lispro, aspart, and glulisine are typical, while regular human insulin can also be used in some settings. In many patients, therapy is delivered by multiple daily injections (MDI), with separate basal and bolus injections, or by an insulin pump that provides continuous basal delivery with bolus doses for meals.

Dosing is individualized based on factors such as body weight, insulin sensitivity, carbohydrate intake, and glucose targets. Bolus doses cover the amount of carbohydrates consumed and include correction doses for high glucose. Education on carbohydrate counting, dose adjustment, and monitoring is essential for effective management.

Benefits include closer approximation of physiological insulin patterns, improved glycemic control, and greater dietary flexibility. Drawbacks include the regimen’s complexity, a higher risk of hypoglycemia, potential weight gain, and the need for regular monitoring and ongoing dose adjustments. Basal-bolus therapy is commonly used in type 1 diabetes and in some people with type 2 diabetes when other regimens do not achieve targets.