Home / Resources / Articles / Beginning Bolus Insulin

Beginning Bolus Insulin

Feb 6, 2014
 

The addition of meal-time bolus insulin can be a big adjustment for many patients with type 2 diabetes…. 

Getting accustomed to three or more injections a day is challenging for many patients. Remembering the injections, timing of administration, and supplies when eating out can also be a hassle.

A recent article written for the Joslin Diabetes Blog focuses on ways to circumvent the challenges associated with the addition of meal-time bolus insulin regimens. They point out that most patients starting the addition of bolus insulin begin with all three meal-time additions at once which can be overwhelming. It may not be necessary for all patients to go immediately from zero bolus injections to all three meal-time injections. To avoid becoming overwhelmed, patients could begin with one meal at a time adjusting to the regimen more gradually.

The article mentions a study comparing two different step-wise approaches to beginning meal-time insulin bolus dosing in patients with type 2 diabetes. Both approaches used insulin aspart and had patients begin with coverage for one meal only. Each group began with injecting 4 units of insulin aspart at meal-time, with weekly dose titration dependent upon the BG readings before the meal for the first group, or after the meal for the second group.

While both groups had similar efficacy in achieving A1c with titration, the group titrating based on post-meal BG levels had more difficulty. The data support the idea that patients have knowledge of which meals are most problematic for them. Additionally, it was found that often, pre-prandial BG values are indicative of glycemic control in patients with type 2 diabetes.

Practice Pearls:
  • Patients with type 2 diabetes may be overwhelmed by beginning bolus insulin with all three meal-time additions at once.
  • Patients generally are aware of which meals in particular are most problematic for them.
  • Pre-prandial BG values may be indicative of glycemic control in patients with type 2 diabetes.

Easing into Meal-time Boluses for People with Type-2. Joslin Diabetes Blog. Posted on Jan 22, 2014. Original article: http://blog.joslin.org/2014/01/easing-into-meal-time-boluses-for-people-with-type-2/