1. Conventional insulin therapy: 2 shots/day
2. Conventional insulin therapy: 3 shots/day
3. Modified Basal Bolus therapy
4. "True" or Classic Basal Bolus therapy
5. Insulin Pump therapy
In conventional insulin therapy, NPH is used as a basal insulin and regular or analog insulin is used as a bolus insulin. These insulins can be mixed together or given separately via insulin pen. In these regimens, three meals and two- three snacks are usually required and carbohydrate counting is recommended to allow for consistent carbs at meals and snacks.
In "modified" basal bolus therapy, Lantus (usually one shot/day) or Levemir (usually two shots/day) is used as basal insulin. Analog insulin (novolog, humalog, or apidra) is given before meals (sometimes during or after, but preferably before) to cover the carbs in the meals or snacks. Lantus and Levemir do not cover carbohydrates and injections of analog insulin must be given to avoid hyperglycemia. Generally, fixed doses of analog insulin are given to cover meals (and sometimes snacks).
In "true" or classic basal bolus therapy, Lantus or Levemir is used as basal insulin. However, analog insulin is given before meals based on the amount of carbohydrates consumed and blood sugar amount. Hence, there is more flexibility in true basal bolus therapy in which an insulin to carbohydrate ratio and correction factor (insulin sensitivity factor) are used to determine the amount of analog insulin required. Accurate carbohydrate counting is essential and generally most families are required to attend classes to learn how to use "true" basal bolus therapy safely and successfully. Lantus and Levemir cannot be mixed together with rapid acting insulin. Each type of insulin is usually given by syringe or pen. In addition, Lantus, Levemir, humalog, novolog and apidra (vials or pens) must be disposed after 30 days of use.
Lastly, insulin pump therapy combines basal and bolus therapy with one rapid acting insulin (humalog, novolog, or apidra). In this situation, insulin is delivered continually in "units/hr" as basal insulin and bolus insulin is delivered by the pump (after buttons are pushed or via PDA) usually when the pumper consumes carbohydrates and/or the blood glucose needs to be lowered. Once again, carbohydrate counting is mandatory for insulin pump therapy. Children's National Medical Center currently offers the following pump choices based on the child/teen and parent preferences: ANIMAS, METRONIC MINIMED, OMNIPOD, and SPIRIT. As you may now know, the DELTEC COSMO pump has been discontinued. However support for those currently using the pump is still available.
Should you have any further questions about insulin, application, choices etc. please do not hesitate to reply by comment or via e-mail. I am happy to explain further to ensure that everyone understands how all the different types of insulin work.
