What is an intensive insulin regimen?
Intensive insulin regimens attempt to mimic the body’s normal pattern of insulin secretion, and deliver replacement insulin using the concepts of basal and bolus insulin coverage.
When you are intensively managed with insulin your medical provider will prescribe an insulin regimen for you, but these are the general principles:
Your insulin regimen will include:
- A basal or background insulin dose
- A bolus insulin dose to cover the sugar or carbohydrate in your food. This will be presented as an insulin to carbohydrate ratio (I:C). The I:C tells you how many grams of carbohydrate can be covered by one unit of rapid acting insulin
- A high blood gluocse correction bolus insulin dose to bring your blood glucose into the target range. This will be presented as a correction factor or insulin senstivity factor (ISF). This correction factor or ISF, refers to how much your blood glucose will drop after 1 unit of rapid acting insulin.
Intensive insulin therapy requires:
- Multiple daily injections of insulin (MDI), or
- Insulin pump therapy
With MDI, glargine, degludec, detemir or NPH is used to provide basal (background) insulin; and insulin aspart, glulisine, lispro or Regular provide bolus (mealtime and high blood sugar correction) coverage.
With an insulin pump, insulin aspart, glulisine or lispro provide both basal and bolus insulin replacement. Intensive insulin therapy, injections or insulin pumps, are designed to mimic the body's natural insulin release patterns.
Advantages of Intensive Insulin Regimens
- While intensive regimens require more calculation at each meal, they allow for more flexibility in timing and in the amount of carbohydrate content in meals and snacks.
- An accurate insulin dose will also result in better blood glucose control with fewer high and low blood glucoses.
- Changes in activity and stress can be accommodated without sacrificing glucose control.
- Over time, high blood glucose correction can be separated from the food coverage. For example, if your blood glucose is very high (over 240 mg/dl), you can delay your meal and give yourself a correcting dose. Once your blood glucose falls below 200 mg/dl, you can inject your meal insulin and then eat.
- Learning these important skills will make managing your Diabetes easier.
Skills check list for intensive insulin therapy:
- Monitor your blood-glucose
(minimum: pre-meal, bedtime, when experiencing a low blood glucose and before driving) - Count your carbohydrates
- Know your insulin regimen (insulin-to-carbohydrate ratio, blood glucose correction or insulin sensitivity factor (ISF), basal dose)
- Understand how different insulin formulations act in your body
- Establish blood glucose goals
(pre meal, post meal, bedtime) - Know how to troubleshoot when your blood glucose is not at your goal
- Understand glucose emergency responses
(such as what to do for low and high blood glucose, and when to check ketones and use glucagon)