Basal and Bolus Insulin for People with Diabetes

Everyone with type 1 diabetes has to take insulin, and some people with type 2 diabetes will need to take it to. Over the past couple of decades, the medical community has made plenty of advances in insulin and insulin delivery. In this article, we'll cover the bolus and basal doses of insulin.

Multiple Daily Injection Program for Diabetics
In the 1980s, the multiple daily injection (MDI) program was developed. Before then, people with diabetes had to eat at a set time—all determined by when their insulin would peak.

New developments in the insulin world, though, led to big changes for people with diabetes. Short-acting (or rapid-acting) insulin was developed that people could take right before eating; it mimics the bolus insulin the body should release in response to more glucose in the blood.

With more options for insulin, the multiple daily injection program came about. With this method, a person with diabetes can take a once-daily long-acting insulin to maintain their basal rate—in addition to bolus insulin right before eating.

There are advantages beyond meal planning. Diabetics on the MDI routine often have better control over their A1c, which may mean fewer long-term complications from diabetes.

Basal Rate and Basal Insulin
The basal rate is the amount of insulin your body requires to maintain normal blood glucose in the absence of food intake.

Your glucose level can vary through the day. For example, it can rise significantly in the presence of physical or emotional stress, illness, infection, etc. There is no one basal rate number applicable to all since it is individual according to lifestyle.

By testing your glucose level regularly on a schedule your doctor suggests, a pattern will emerge over a 1 or 2 week period. This will determine how much basal insulin you will need and when throughout the day to administer it.

Your doctor can adjust the kind of insulin(s) you will require and when the most appropriate time is for you to take it.

If you have an insulin pump, your certified diabetes educator will teach you how to set the basal rate (and that rate will be determined in consultation with your doctor).

Bolus Insulin
A bolus, in the matter of insulin administration, is a single dose—usually with a short-acting insulin. People with diabetes will often give themselves a bolus when adjusting for meals or other occasions when the glucose level has extended beyond the normal range.

Just as with your basal insulin, your doctor and diabetes treatment team will work closely with you to help you fully understand bolus insulin and giving yourself a bolus.

Bolus and Basal Insulin Tips
At first, all these injections may seem scary or overwhelming. Keep in mind a few things:

  • Talk to your doctor and diabetes treatment team. They are there to answer your questions and make sure that you are living life fully with diabetes. If you don't understand something or if you think your insulin schedule needs to be adjusted, talk to the team.
  • With practice, this will be easier. Especially for people who have just been diagnosed with diabetes (or for parents with a diabetic child), insulin can be intimidating. As you do this more and pay attention to how your body reacts, you will become better at this.
  • You're being healthy and proactive. Working to keep your blood glucose levels in the goal range can hard—but it's worth it. You're taking care of your daily health, as well as working to prevent long-term complications of diabetes (such as diabetic neuropathy or diabetic retinopathy).