How to Explain Basal Insulin to Your Patient
Basal insulin is a once-daily, long-acting insulin that works continuously throughout the day and night to control your blood sugar between meals and overnight by mimicking the small, steady amount of insulin your pancreas would normally release. 1
What Basal Insulin Does
- Basal insulin controls your "background" blood sugar by restraining your liver from releasing too much glucose, particularly overnight and between meals 1
- It provides approximately 24 hours of steady insulin coverage without causing peaks or sudden drops in insulin levels 2, 3
- This is different from mealtime insulin, which handles the sugar spikes that occur after eating 4, 2
Starting Your Basal Insulin
You will typically start with 10 units once daily or 0.1-0.2 units per kilogram of your body weight, depending on how high your blood sugar is 5, 6
- The dose is injected under the skin (subcutaneously) into your abdomen, thigh, or upper arm 6
- You must take it at the same time every day (though the specific time can be any time that works for your schedule) 1, 6
- You should continue taking your metformin and possibly other diabetes pills alongside basal insulin 5
How We'll Adjust Your Dose
Your dose will be increased by 2-4 units every 3-7 days until your fasting blood sugar reaches 80-130 mg/dL 5, 7
- You'll need to check your fasting blood sugar (first thing in the morning before eating) to guide these adjustments 1, 5
- If you experience low blood sugar (hypoglycemia), we'll reduce your dose by 10-20% 1
- Patient self-titration using a written algorithm improves blood sugar control, so you may be given instructions to adjust your own dose based on your readings 5
Important Safety Information
Rotate your injection sites within the same body region (for example, different spots on your abdomen) to prevent lumps or skin changes that can affect insulin absorption 6, 8
- Never inject into areas with lumps or skin changes 6
- Do not mix basal insulin with any other insulin or dilute it 6
- Learn to recognize and treat low blood sugar: symptoms include shakiness, sweating, confusion, and rapid heartbeat 1, 5
- Always keep fast-acting sugar (glucose tablets, juice) available 5
When Basal Insulin Alone Isn't Enough
If your A1C remains above goal after optimizing basal insulin, or if your blood sugar spikes significantly after meals (above 180 mg/dL), you'll need to add mealtime insulin or a GLP-1 medication 1, 7
- Signs you need additional medication include: high bedtime-to-morning blood sugar differences (≥50 mg/dL), continued high A1C despite reasonable basal doses, or frequent low blood sugars 1
- We prefer adding a GLP-1 medication before adding mealtime insulin because it causes less weight gain and fewer low blood sugar episodes 1
Common Misconceptions to Avoid
Starting insulin does not mean you've failed – type 2 diabetes is a progressive disease where the pancreas makes less insulin over time, and insulin therapy is often necessary and beneficial 1
- Insulin is not a punishment; it's a powerful tool to prevent complications 1
- Delaying insulin when needed prolongs exposure to high blood sugar and increases your risk of complications 7
- Basal insulin alone will not control blood sugar spikes after meals – that requires additional medication 1, 4