Basal Bolus

• If used properly it may lead to better control (lower HbA1c)
• It will allow more flexibility with meals and meal times.
• It can lead to more stable blood glucose levels without hypos.

Before changing to this you should discuss with your parent(s) and the diabetes team: -

• What you feel about 4 or more insulin injections per day
• How you will inject at school
• The need to learn more about food, carbohydrate counting and insulin adjustment

Insulin Type

Basal insulin (insulin Glargine and Detemir)

This gives a background level of insulin over 20-24 hours.

Bolus insulin (NovoRapid or Lispro)

This is given with meals and lasts 4-6 hours.  You will have to carbohydrate count your food and be able to work out how much insulin is required for each meal.

Your basal insulin dose will be calculated by your Diabetes Team but is adjusted based on your pre-breakfast blood glucose.  This should be about 8.0mmol/L.  If it is too high (10 or more) or too low (6 or less), discuss with your diabetes nurse.

To check your bolus insulin dose is correct, you have to check your blood glucose before a meal and then 2 & 4 hours after.  These blood glucose levels should be nearly the same.

It's important NOT to miss your insulin.  You should have insulin at least 4 times per day when you eat meals or large snacks (30g carbohydrate or more).

If you eat extra snacks then you need to cover them with insulin and this can mean extra injections.  If you have a snack regularly (e.g. bedtime), this can be counted in with your evening bolus injection.

If you blood glucose is high before meals, you can give yourself a little extra insulin.  The average is 1 unit of NovoRapid for every 2-5mmol/L your blood glucose is above 10mmol/L.  Discuss this with the Diabetes Nurses.