From the Guidelines
To convert from a basal-bolus insulin regimen to pre-mixed insulin, start by calculating the total daily insulin dose from the current regimen and divide it into two equal doses to be administered before breakfast and dinner using a pre-mixed insulin. When converting to pre-mixed insulin, it's essential to consider the patient's meal patterns and carbohydrate intake, as pre-mixed insulins require more consistent meal timing to avoid hypoglycemia 1.
- Calculate the total daily insulin dose from the current basal-bolus regimen by adding all basal and bolus doses.
- Divide this total into two equal doses to be administered before breakfast and dinner using a pre-mixed insulin such as 70/30 NPH/regular insulin mix or a 75/25 or 50/50 lispro mix.
- For most patients, start with 50% of the total daily dose in the morning and 50% in the evening, but adjust according to the patient's carbohydrate consumption at different meals.
- Monitor blood glucose levels closely during the transition, checking before meals and at bedtime for at least one week, and adjust doses based on patterns: increase morning dose for high pre-dinner readings and increase evening dose for high fasting morning readings 1. This conversion is particularly suitable for patients who struggle with multiple daily injections or have stable, predictable eating patterns, as it simplifies the regimen but offers less flexibility than basal-bolus therapy.
From the Research
Conversion from Basal Bolus Regimen to Pre-mixed Insulin
- The conversion from a basal bolus regimen to pre-mixed insulin is a complex process that requires careful consideration of the patient's individual needs and medical history 2.
- Studies have shown that pre-mixed insulin can be an effective alternative to basal bolus regimens for patients with type 2 diabetes, but it may increase the risk of hypoglycemia 2.
- When converting from a basal bolus regimen to pre-mixed insulin, it is essential to monitor the patient's blood glucose levels closely and adjust the insulin dosage as needed to minimize the risk of hypoglycemia 2.
- The safety and efficacy of pre-mixed insulin formulations in the hospital setting are not well established, and more research is needed to determine the best approach for converting patients from basal bolus regimens to pre-mixed insulin in this setting 2.
Key Considerations
- The patient's individual needs and medical history should be taken into account when converting from a basal bolus regimen to pre-mixed insulin 2.
- The risk of hypoglycemia should be carefully monitored and managed when converting to pre-mixed insulin 2.
- More research is needed to determine the best approach for converting patients from basal bolus regimens to pre-mixed insulin, particularly in the hospital setting 2, 3.
Available Evidence
- There is limited evidence available to guide the conversion from basal bolus regimens to pre-mixed insulin, and more research is needed to fill this knowledge gap 2, 3.
- Studies have shown that basal bolus therapy with insulin glargine and insulin lispro can provide effective glycemic control and minimize the risk of hypoglycemia 3.
- However, these studies do not provide direct guidance on converting from basal bolus regimens to pre-mixed insulin, and more research is needed to address this specific question 2, 3.