Insulin isn’t one-size-fits-all. There are different insulins you can use to control your blood sugar levels, and they’re classified by how quickly they work. Basal insulin is one type of therapy. (1) And if you require this insulin, it’s important to understand how it works and how it differs from other types of the drug.
What Is Basal Insulin and How Can It Help Control Diabetes?
Basal insulin is an important component in diabetes management because it acts as a background insulin. (2) It’s designed to stabilize your blood sugar during periods of fasting, such as in between meals and while you’re asleep. Insulin also plays a role in how you metabolize carbohydrates. After eating, your body breaks down carbs from food into sugar or glucose to energize your body and enable you to walk, eat, perform tasks at work, and more. This breakdown increases your blood sugar level, and in response to this higher level, your pancreas releases insulin into your bloodstream. (3) RELATED: How to Stabilize Your Blood Sugar Insulin helps your body’s cells absorb the glucose in your bloodstream, providing you with that essential energy. Some glucose remaining in your blood gets stored in your liver, and then slowly forms and releases into your bloodstream when there’s a demand for fuel. (1) Because people with type 1 diabetes don’t make their own insulin, they need to take injections of basal insulin to manage their blood sugar. But if you have type 2 diabetes, your body still produces insulin. The issue is your pancreas may not produce enough insulin to maintain a healthy glucose level. (1) That’s why your doctor may recommend using basal insulin at some point in your treatment. Between 75 percent and 90 percent of people with type 2 diabetes require injections. (4) Basal insulin absorbs slowly and is long-lasting, which helps keep your blood sugar level stable when your liver releases extra glucose. RELATED: 7 Signs Your Blood Sugar Is Out of Control
What’s the Difference Between Basal and Bolus Insulin?
Along with basal insulin, bolus insulin is a treatment option for type 2 diabetes. (5) While basal insulin works as a background insulin to supply your body with insulin during periods of fasting, bolus (or mealtime) insulin is a rapid or fast-acting insulin that works quickly, but there’s a catch: Its blood-sugar-lowering effect doesn’t last as long. (5)
Humalog (lispro)NovoLog (aspart)Apidra (glulisine)Humulin R (regular)
RELATED: Signs of High and Low Blood Sugar You Need to Know
When to Consider Using Basal-Bolus Insulin for Blood Sugar Control
If you have type 1 diabetes, you will require a combination therapy called basal-bolus insulin. This therapy includes an injection of rapid or fast-acting insulin before meals, as well as a daily injection of background basal insulin. (5) Because your body doesn’t make insulin, it’s key to work with your doctor to come up with an effective treatment approach.
Does Living With Type 2 Diabetes Mean You Need to Take Insulin?
Not always. Many people living with type 2 diabetes may not need basal insulin, or at least not right away. Because your body is still able to produce insulin, dietary changes, physical activity, and oral medication may help your body overcome insulin resistance and use this hormone properly. (7) Losing weight and adding 30 minutes of regular physical activity five days a week can help your body respond to its own insulin so your cells can naturally absorb glucose. (8) You can also help improve your body’s response to its own insulin by eating fewer starchy, sugary foods, and eating more low-calorie foods like fruits and vegetables. (9) Your doctor may also prescribe the oral medication Glucophage (metformin), which helps control high blood sugar by limiting the amount of sugar produced by the liver. (10) RELATED: Does Metformin Cause Weight Loss? What to Know Before You Take It If diet, lifestyle changes, and medication aren’t enough to control your blood sugar, you may need to consult your doctor about adding basal insulin your treatment regimen. Signs that you may need insulin therapy include:
Increased thirstFrequent urinationBlurry visionFatigue
Note that these mimic early signs and symptoms of diabetes. (11)
Choosing Basal Insulin: Which Type Is Best for You?
Three types of basal insulins are available to help control your blood sugar, and you can work with your doctor to determine the best type and dosage for you. Types of basal insulin include: Intermediate-Acting Insulin (4)
- NPH: Humulin N (isophane) and Novolin N
Injected once or twice a day and active two hours after injectionPeaks at six to eight hoursLasts between 10 and 16 hours
Long-Acting Insulin 1. Lantus (glargine or Toujeo) and Basaglar
Injected once a day and active two hours after injectionLasts between 20 and 24 hours
2. Detemir (levemir)
Injected once or twice a day and active two hours after injectionLasts between 14 and 24 hours
Ultra-Long-Lasting Insulin 1. Tresiba (degludec)
Injected once a day and active 30 to 90 minutes after injectionLasts for up to 42 hoursGood if the time that you inject is not always the same (for example shift workers)
RELATED: What Is Insulin?
Potential Benefits of Using Basal Insulin
Some people prefer basal insulin because it provides greater flexibility. Unlike mealtime insulin, which has to be taken before each meal, basal insulin needs to be injected only one or two times a day. Because this insulin is long-acting, you don’t have to time your injections around meals, and it can keep your blood sugar stable for longer periods of time.
A Quick Guide to Help You Inject Basal Insulin
Basal insulin requires a daily injection. Options include an insulin pen with a prefilled cartridge containing your insulin dose, or a syringe that you fill with your prescribed dose from an insulin bottle. Insulin doses vary, and your doctor will determine how much insulin you need to manage your diabetes. Insulin is not injected into muscles or veins, but rather into the tissue underneath your skin. Your doctor will show you how and where to administer your doses. Most likely, you’ll inject insulin in your abdomen so that it can quickly absorb into your bloodstream. Insulin injected into your arm or thigh takes longer to reach the bloodstream. (12) Wash your hands and clean the injection site with alcohol before injecting. Grab or pinch a fold of your skin, and then inject the needle at a 90 degree angle. If you’re thin, you may have to inject the needle at a 45 degree angle instead. (13) Be sure to rotate your injection site. If you inject insulin into the same spot every day, fatty deposits could develop in this area and reduce insulin absorption. (14) It’s also important that you don’t reuse or share your needles with anyone, and you must make sure your insulin is stored properly and not expired. (13) An insulin pump may be an option if you take basal insulin along with a rapid-acting insulin before meals. This is a small device that delivers insulin 24 hours per day, depending on your body’s needs. Insulin enters your body through a catheter attached underneath your skin. (15) RELATED: The Dos and Don’ts of Insulin Injections
Dosages and Fine-Tuning Your Basal Insulin Regimen
The dose of intermediate-acting, long-acting, and ultra-long-acting insulin you receive is based on your lifestyle and your body’s insulin needs. When you begin taking insulin injections, your doctor may prescribe one injection per day based on your weight, and then fine-tune or adjust your dose later on. If you’re new to basal insulin, your doctor will likely start your dose at 10 units a day at bedtime, although many people require between 40 and 50 units. (16) Make sure you monitor your blood sugar levels before and after bed. Ideally, your glucose level should increase or decrease no more than 30 milligrams per deciliter (mg/dl) while you’re asleep. (17) Any greater or lower change could indicate the need to adjust your insulin dose. Speak with your doctor to determine the right amount of insulin. Some people must use a combination of insulins to manage their blood sugar. You can’t mix determir, glargine, or degludec with fast-acting insulins. NPH can be mixed with fast-acting insulins, and in fact it can be prescribed in a premixed container. This includes 70 percent of NPH insulin with 30 percent of a regular insulin (Humulin R), or your doctor may prescribe NPH with Humalog or NPH with NovoLog. (4) RELATED: 10 Surprising Causes of Blood Sugar Fluctuations
Potential Side Effects of Basal Insulin
It’s important to take the appropriate dose of basal insulin to avoid sending your blood sugar levels plummeting, causing hypoglycemia (low blood sugar). This may occur if you take too much insulin. Signs of hypoglycemia include:
ConfusionShakinessRapid heartbeatHeadacheSeizures
If you have these symptoms, eat a few crackers or a piece of hard candy to help reverse the condition. RELATED: The Best Bites to Boost Low Blood Sugar There’s also the risk of developing an allergic reaction at your injection site. Signs of a reaction include itchiness, redness, and swelling. If you’re allergic to an insulin, you may experience nausea and vomiting. (18) Talk to your doctor if you experience hypoglycemia or signs of an allergic reaction. Your doctor may need to adjust your dose or prescribe a different type of insulin.
The Takeaway: The Right Dose and Type of Insulin for a Healthy Life
Insulin is instrumental in energizing your body. If your body doesn’t make insulin or use insulin properly because of type 1 or type 2 diabetes, basal injections can help stabilize your blood sugar and reduce the likelihood of diabetes complications like kidney damage, eye damage, nerve damage, and heart problems. Make sure you follow your doctor’s instructions and take your insulin as prescribed. If you feel your insulin isn’t working effectively, speak to your doctor about fine-tuning your dosage. Kaiser Permanente The Diabetes Council British Diabetes Association Beyond Type 1 Diabetes Self-Management Centers for Disease Control and Prevention National Institutes of Health The Johns Hopkins Patient Guide to Diabetes
