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Basal or Bolus. What's the difference?


Basal or Bolus. What's the difference?

Where did the term basal and bolus come from? Furthermore, what the heck is the difference?

Being new to diabetes you start to hear new terms that you're unfamiliar with like basal and bolus but the basal we're talking about isn't the kind you cook with (that's basil). 

If you're like me, you kind of feel stupid asking the question because everybody around you seems to know the difference between basal and bolus. You may hear a nurse or doctor say things like "I think we just need to increase your basal." And I'm thinking... which one is that, because I'm looking at NovoLog and Levemir? You don't ask the question but you keep picking up on clues of what this may mean.

I'm going to make it simple for you. Basal and bolus are exactly the same thing, but different. Ok, not so simple. Basal and bolus are terms used for insulin injections. The basal is the long acting insulin that is "always" running in the background. If you're on a pump your pump would administer tiny little bit of insulin over the course of an hour. These little bits (a set amount) of insulin administered over the course of an hour, continuously over the course of 24 hours is what tries to keep your insulin in-check or in balance. If you're still on injections you might be using something called Lantus or Levemir. These are long acting insulins and they typically last 24 hours in the body and are slow acting so the insulin is released slowly over the course of 24 hours. You will usually take this shot once a day. 

From the photo above you can see that there are several different basal rates set throughout the day. This is because my son is very active on Tuesday's & Wednesday's and when he has too much basal and he is exercising his blood sugar drops low so I have several "profiles" set up throughout the day to help prevent his blood sugar from going to low. This is the t:slim X2™ Insulin Pump.

Bolus (quick/rapid acting) is the insulin you take at each meal or snack. You probably use a quick/rapid acting insulin called Humalog or NovoLog. If you're on the pump then you'll simply take the number of carbs you have eaten and your current BG (blood sugar) and enter that into the pump. The pump will administer exactly the amount of insulin you will need to counteract the food you will be ingesting. If you're still on injections then you will simply give yourself an injection based on the amount of carbs you will be eating and your current BG. You may need a correction bolus if your blood sugar is higher than the recommended amount set by you doctor or endocrinologist. 


So let's make this as simple as possible. Basal is the insulin you get in the background that's running all the time whether you've given yourself one injection (typically lasts 24 hours) or you're on a pump. Bolus is the injection you give yourself before you eat a meal/snack or for a correction. It's really simple but when you start hearing doctors and nurses and nutritionist throwing around the word basal and bolus you get a little bit confused especially when this is new. So let's keep it simple. Basal (slow background) Bolus (fast/rapid)

Now I've always wanted to know where these terms actually come from or originate. After some research on Wikipedia. Here is the link to the basal definition. 

Wikipedia says bolus is a Latin term (ball) and is the administration of a discrete amount of medication. See full description here.
I was really hoping it would be something more significant than that but turns out these are just common terms used for multiple areas of medicine.

So the next time somebody talks to you about bolus and basal hold your head up high, look them in the eye and say yeah I know the difference. You can now feel confident that it really is as simple as you thought it was. They are very similar, and some may even say they are the same thing. One is long-acting and one is rapid/quick acting. 


Examples of quick/rapid acting insulin: 
Insulin glulisine (Apidra)
Insulin lispro (Humalog)
Insulin aspart (NovoLog
See more at: quick/rapid acting

Examples of long-acting insulin: 
Insulin detemir (Levemir
Insulin glargine (Lantus
See more at: long acting

Now, the more you start diving into diabetes you're going to start to seeing all sorts of things online. Somethings that work great for you and your family and other things that don't. One video that I recently ran across talked about an inhaled insulin called Afrezza. It is very interesting and intriguing although it will not work for my seven-year-old T1D son. They don't recommend it for people with asthma, which of course he has, and they only recommend it for those who are 18 years or older. Again, it was very interesting and I would highly recommend watching this video if you are over 18 yrs old and meet the general requirements that you discuss this with your doctor. Video link here video link here

Inhaled insulin begins working within 12-15 minutes, peaks by 30 minutes, and is out of your system in 180 minutes. Types: Technosphere insulin-inhalation system (Afrezza)

Remember just because somebody recommends it or it works for them, that doesn't always mean it will work for you. Always speak to your doctor before making any changes to your health care plan.



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