Basal and Bolus difference.

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Tom1982

Tom1982

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I should really know this by now. Is it as simple as one is fast acting and one is slow? Are they totally different types or just delivered differently? How come some people only use Basal???
 
Basal is the background insulin - so like as you said it’s slow release. Bolus is meal time insulin and that sort of thing - so like you said it’s fast acting. Basal is a different type of insulin as it’s slower release (in a pump it’s the same insulin as bolus but released in very small doses in the background)
 
There is no reason to know this. Don’t worry about asking a “stupid” question. There aren’t many.

I think of basal as the “base” insulin which manages the glucose dripped from your liver all day every day.
Bolus in the other one - it doesn’t sound like any word I knew before diabetes so I have no better way of explaining it.

When injecting, the basal is dealt with via long acting insulin with a flattish profile. On an insulin pump, fast acting insulin is used and pumped throughout the day and night.
Bolus is always fast acting and is used for food and when our livers don’t behave consistently and need a top up such us when we are stressed.

Most people with Type 1 use both. When diagnosed as an adult, our insulin producing cells die slowly so during our “honeymoon period” we may have enough of these cells to get us through the bolus but they need a helping hand for the basal.
I have less knowledge about type 2 but some people with type 2 also seem to use basal only.

As an added bonus, there is also “mixed insulin”. If you looked at the action profile of mixed insulin you would see a background level all the time plus spikes throughout the day. This was what I used for the first few months of my diagnosis but is rare for Type 1 treatment now as it is inflexible- you have to eat to match the spikes so a fixed amount of carbs at fixed times of the day.

i think that’s all I know on the topic. Feel free to keep asking questions.
 
Tom1982 said:
I should really know this by now. Is it as simple as one is fast acting and one is slow? Are they totally different types or just delivered differently? How come some people only use Basal???
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They do a different job. A non-diabetic person releases tiny amounts of insulin every few minutes as background/basal. Obviously we don’t want to have hundreds of injections a day so we use a modified slowed down insulin as a basal and inject it once or twice a day. Then use a normal fast insulin to deal with our meals (bolus).

A pump only uses fast insulin just like the human body. It releases tiny amounts very frequently to act as basal insulin, and then the user boluses to release larger amounts to deal with food.

We need a basal insulin even in the absence of food because glucose is released by the body and without insulin our blood sugar would go too high even if we didn’t eat.
 
Basal insulin is an insulin which has been modified to release more slowly and the idea is that matches, as best as possible, the release of glucose by the liver which trickles out small amounts glucogen to supply the vital organs with energy in the absence of food/carbs.... ie between meals, when fasting/sleeping etc. I think of the liver as a back up battery that keeps the the heart and brain and lungs working when we aren't sleeping and then recharges itself when there is food in the system. So the basal insulin enables the body to access the glucose that the liver releases to keep things ticking over.
The pancreas just produces one insulin and trickles out tiny amounts all the time to deal with the glucose from the liver and larger amounts to deal with food, Insulin pumps work in a similar way but not nearly as effectively.... so they only use quick acting insulin and pump tiny amounts every few minutes I believe to cover the glucose that the liver provides and then larger bolus amounts for food . It can be programmed to deliver different rates of basal insulin at different times of the day and night as out bodies usually need less through the night and more through the day, particularly in the morning, so having that option to change the basal rate for different periods of the day means that you can match the individual bodies basal needs much more closely.

The bolus insulin hasn't been modified to release slowly so it acts as quickly as the body is able to absorb it (which is not nearly quick enough for many of us) to deal with the glucose released from the food we eat and enable our bodies to use it for our daily activity and/or store any surplus for later.
 
helli said:
Bolus in the other one - it doesn’t sound like any word I knew before diabetes so I have no better way of explaining it.
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I first came across the term ‘bolus’ in school biology as the chewed ball of food that you swallow. (oh the irony!)

I think the literal meaning is something like ‘lump’.

So you have the base (basal) of long-acting underneath, and the lump(s) that you put over the top for meals, snacks, corrections etc.

🙂
 
Me too - not an attractive term, but I don’t think of that now (chewed up food) only the insulin usage. Perhaps we should have a nicer name?
 
Cheers for clearing that up everyone. So there isn’t two different types in a pump then? Just a kinda constant drip and then you input a meal time amount by carb counting as usual?
 
Tom1982 said:
Cheers for clearing that up everyone. So there isn’t two different types in a pump then? Just a kinda constant drip and then you input a meal time amount by carb counting as usual?
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Yes, just one type - fast insulin - programmed to drip away in tiny amounts continually, with meals boluses via the pump after carb counting.
 
Tom1982 said:
Cheers for clearing that up everyone. So there isn’t two different types in a pump then? Just a kinda constant drip and then you input a meal time amount by carb counting as usual?
Click to expand...
Yep! However as we've been explaining today to a lady whose 4 yo daughter has just moved to a pump and was started on a level base rate for all of the 24 hrs a day - bodies very rarely need exactly the same amount of insulin throughout the day and night so to begin with there's an awful lot of tweaking of basal rates needed. Then with a little child - even more things change quickly and alter the need for insulin - growth hormones for starters - and of course once puberty hits especially with girls, all the extra hormones for that but at least you'll have a few years respite for that!
 
Tom1982 said:
Cheers for clearing that up everyone. So there isn’t two different types in a pump then? Just a kinda constant drip and then you input a meal time amount by carb counting as usual?
Click to expand...

No more complicated than that, good thing that drip can be slowed up or accelerated to your body's demands, which basal from pen could never do.
 
Tom1982 said:
Cheers for clearing that up everyone. So there isn’t two different types in a pump then? Just a kinda constant drip and then you input a meal time amount by carb counting as usual?
Click to expand...

nonethewiser said:
No more complicated than that, good thing that drip can be slowed up or accelerated to your body's demands, which basal from pen could never do.
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Yes that’s a hugely important aspect of pump therapy for me.

Once a long-acting insulin is in, it’s in. And you can’t change it.

But with a pump, you can suspend basal insulin if more active/exercising, or increase it to slow an upward BG drift.
 
everydayupsanddowns said:
Yes that’s a hugely important aspect of pump therapy for me.

Once a long-acting insulin is in, it’s in. And you can’t change it.

But with a pump, you can suspend basal insulin if more active/exercising, or increase it to slow an upward BG drift.
Click to expand...
Yes great piece of kit, couldn't go back to pens.
 
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