Basal insulin use: everything you need to know

Basal insulin is the concentration of the hormone, sufficient during fasting, to maintain blood glucose levels within normal limits. Its artificial forms are part of the treatment of diabetes.

Last update: September 17, 2022

Insulin is a hormone secreted by the pancreas, whose main function is to stimulate cells to capture glucose circulating in the bloodstream. Continuous secretion generates a concentration known as basal insulinthat maintains normal blood sugar levels during the period between meals.

Additionally, when food is consumed, extra insulin loads are released from the pancreas to cope with the increase in glucose from the diet. This produces hormone levels higher than basal insulin, called postprandial.

How important is basal insulin?

In some patients, insulin values ​​may be increased, predisposing them to the development of diabetes mellitis type 2. This situation is known as insulin resistance.

For various reasons, the usual concentration of the hormone is not sufficient to maintain adequate blood glucose levels. Thus, the pancreas tries to compensate for this defect by releasing even more insulin molecules.

In contrast, in patients with diabetes mellitis type 1, the pancreas stops producing insulin, detecting decreased values ​​of the hormone. In these cases, it is necessary to implement therapies with exogenous insulin to prevent the complications of diabetes. It is here that basal insulin becomes important as medication.



Types of insulin available

Currently, there are several insulin options available, which are classified depending on the duration of the effect they produce. Short-acting insulin, also called regularhas analogues: lispro, asparts Y glulisine. Prevent spikes in blood glucose after mealsresembling the effect of postprandial insulin.

On the other hand, intermediate-acting (NPH) and long-acting insulins (glargine, stop Y degludec) try to maintain insulin values ​​during fasting periods. Because of that, this group of substances is considered the basal insulin of diabetic patients. The purpose of this therapy is to allow the cells a constant input of glucose as an energy source, but without causing hypoglycemia.

It is important to note that there are devices designed to administer insulin continuously and automatically (insulin pumps). They are small devices and use rapid-acting insulin. However, by providing constant concentrations throughout the day and night, they are often considered part of the basal insulin.

The variety of insulins on the market is increasing. There are new developments and new application devices.

Characteristics of basal insulin

Being a long-acting drug, basal insulin is usually indicated once or twice a day. The choice of administration schedule depends on the characteristics of each type of insulin and the intrinsic factors of each patient.

For this reason, insulin therapy and its adjustments should always be carried out by a specialist doctor. Better, with a professional who has experience in managing diabetes mellitis.

NPH (neutral protamine Hagedorn): intermediate-acting insulin

NPH insulin is a whitish suspension containing zinc and protamine. This last molecule delays the absorption of insulin, prolonging its effect.

The duration of its action can last up to 16 hours, which is why it is usually indicated twice a day. However, nocturnal administration has not shown good blood glucose values ​​the next morning.

Long-acting analogs

Human insulin analogs have modifications in some amino acids of the hormone, which produces a prolonged effect. They generally do not have a maximum peak of action, thus reducing the risk of hypoglycemia.

The most relevant features are described below:

  • Insulin glargine is dissolved in an acid medium, giving it a crystalline appearance, like that of regular insulin. Subcutaneous administration provides an adequate basal insulin concentration, so it can be indicated only once a day. It should not be mixed with other types of insulin.
  • stop is an insulin that has a fatty acid in one of its chains. This molecule binds to blood proteins when it is absorbed, prolonging its action. It has the advantage of producing less hypoglycemia than glargine. It should usually be given 2 times a day.
  • Insulin degludec, meanwhile, when injected into the subcutaneous tissue, creates large molecules that slowly dissociate, producing a prolonged effect. In addition, it also binds to albumin, delaying its effect. It can be indicated only once a day.

Insulin therapy: what you should know

In general terms, about 50% of the daily insulin dose in a patient with type 1 diabetes should be administered as basal insulin, while the other 50% must cover meals. However, some factors must be taken into consideration. The main objective is to maintain adequate blood glucose levels.

In the same way, the calculation of the daily dose recommended by the American Diabetes Association (ADA) ranges between 0.4 and 1 international unit (IU) for each kilogram of patient weight. The choice of dose is also individualized, since it depends on age and the presence of some associated condition.

In those patients with diabetes mellitis type 2 who are prescribed insulin therapy, the ADA advises that the requirements of the hormone be covered with basal insulin associated with an oral hypoglycemic agent. In these people, the dose is estimated between 0.1 and 0.2 IU per kilogram of weight per day.

The insulin dose is calculated in detail so as not to cause adverse effects. Each patient should receive a scheme according to their particularities.

Important factors to consider with basal insulin

The route of insulin administration is subcutaneous., requiring multiple injections during treatment. The preferred site is the fatty tissue of the abdomen, but the thighs, buttocks, and arms are also suitable.

It is important to change the location frequently to avoid the development of lipohypertrophy. Similarly, special insulin needles, which are short, must be used in order to avoid intramuscular administration.

On the other hand, it is necessary to stimulate improvements in the patient’s lifestyle. Incorporating a balanced diet with proper nutritional advice and exercising regularly have been shown to have a positive effect on glycemic control.



How is the follow-up of patients with insulin therapy?

Diabetic patients should be educated about their condition so that they have the ability to actively participate in their treatment. Control of capillary blood glucose is an essential resourcesince it allows close monitoring, in real time, of the effect of insulin on the patient.

Likewise, the regular detection of glycosylated hemoglobin serves to evaluate the effectiveness of insulin treatment in the medium term. Today it is an essential method to decide to maintain or modify the therapeutic scheme.

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