The Basal/Bolus Approach

Think Like a Pancreas: Chapter 5, Your Cheat Guide!

The liver’s main function is to store glucose (in a dense compact form called glycogen ) and secret it steadily into the bloodstream.  This provides your body’s vital organs and tissues with a constant source of fuel. “This is what keeps your heart beating, brain thinking, lungs breathing, and digestive system, uh, digesting all the time.” (Scheiner).

A working pancreas typically puts out small amounts of insulin into the bloodstream every couple minutes. This the purpose of your basal insulin (i.e. long lasting insulin). Too little basal insulin = sharp rise in blood sugar levels. 

Each person’s basal insulin requirement is unique, but typically, basal insulin needs are highest during the night and early morning and lowest during the middle of the day.

Why more in the morning? Dawn phenomena—sugar raising hormones. 

Why less during the day? Physical activity—i.e. moving around increases your sensitivity (response) to insulin. 

Basal (long lasting) insulin can be supplied in a variety of different ways: 

A. Intermediate-acting insulin (NPH)—covers insulin needs for about half the day or overnight. This type of insulin is often combined with a rapid- or short-acting type. 

B. Long-acting insulin (Lantus, Levimer)—covers insulin needs for about one full day. This type is often combined, when needed, with rapid- or short-acting insulin. Offers (typically) peak-less insulin levels for approximately 24 hrs. 

C. Insulin Pumps— deliver rapid-acting insulin in small pulses throughout the day and night; peak or action time is not an issue.  Pump therapy allows for best basal insulin coverage.

Gary discusses (6) insulin therapy options, below are the (2) go-to therapy's:

The Muscle Car: Breakfast, Lunch, Dinner, Snacks: Humalog/Novolog. Any time of day, consistently: Lantus.

Overview: Long lasting insulin may dissipate earlier than 24 hours, but for most, it provides a steady level of basal. Its consistent absorption minimizes the risk of hypos. Multiple injections are not ideal, but provide rapid-acting response to cover meals and snacks. This regimen sometimes produce high readings in the morning (dawn phenomenon not covered) or lows in the middle of the day (as basal insulin needs tend to lessen). 

The Engineered Import: Insulin Pump Therapy.

Overview: Offers the ability to fine-tune and adjust basal insulin levels throughout the day and night. Allows great freedom and flexibility in terms of food, activity and sleep patterns. Basal insulin levels can be adjusted for events such as menstrual cycles, pregnancy, stress, illness and extended exercise.


Basal/bolus therapy varies person to person. There is no one size fits all.  Learn and listen to your body, chat with your health specialist, and adjust accordingly to your specific needs and/or lifestyle preferences. Your body is ever changing. Whether it’s stress, hormonal imbalances, pregnancy, increase in fitness level, each bring the need for small (or large) insulin adjustments.


Fast. This will shed light on whether or not your basal is correct. Holding steady and not trending high or low (rise or drop of 30mg) is the goal. If your basal is not correct, it’s very difficult to keep happy blood sugars!

Log.  Trends are best discovered when written down! Adjusting your dosing for your body’s needs shouldn’t be a guessing game. It’s complex and needs your attention!

Open Mindedness. Poor control? Feeling tired of the pump? Don’t feel stuck! Reach out to others and speak with your physician about making a therapy transition if you feel you need to change things up. 

Until next week....