perusinsuliinilääkityksessä

Perusinsuliinilääkitys, also known as basal insulin therapy, is a foundational treatment for type 1 diabetes and for many patients with type 2 diabetes who require insulin. The goal of basal insulin is to maintain stable blood glucose levels between meals and overnight, mimicking the liver’s natural release of glucose. Basal insulin is typically dosed once or twice daily before meals, depending on the specific insulin formulation.

Basal insulin preparations are divided into long‑acting, intermediate‑acting, and ultra‑long‑acting categories. Long‑acting analogues such as glargine and detemir provide a flat, steady insulin concentration over 24 hours, whereas ultra‑long‑acting analogues like degludec extend coverage beyond 24 hours, offering more flexibility for dosing and potentially reducing hypoglycaemia. Intermediate‑acting preparations, such as NPH insulin, are less commonly used as basal therapy in contemporary practice due to their higher risk of glucose excursions.

Initiation of basal insulin usually involves a starting dose based on body weight or estimated insulin requirement, with subsequent titration guided by fasting plasma glucose or self‑monitoring of blood glucose (SMBG) readings. Patients are instructed to adjust the dose in 10–20 µg increments until target fasting levels are achieved. Education on carbohydrate counting, recognition of hypoglycaemia, and appropriate insulin administration technique is essential for successful therapy.

Complications associated with basal insulin include hypoglycaemia, weight gain, and rare immune reactions. Regular monitoring of glycated haemoglobin (HbA1c) and SMBG trends helps assess efficacy and safety. Basal insulin therapy can be combined with prandial (bolus) insulin or other antidiabetic agents to achieve comprehensive glycaemic control.