Regimens:

Basal-bolus regimen

Description
Multiple daily injections of short-acting insulin or rapid-acting insulin analogue before meals (BOLUS), in addition to one or more separate daily injections of intermediate-acting insulin or long-acting insulin analogue (BASAL)

Key points
Regimen mimics the normal pattern of insulin release in the body and affords treatment flexibility around food intake. Approximately 50 per cent of insulin produced in a 24-hour period is released during periods of fasting or sleeping and is referred to as basal insulin

Basal (or background) insulin helps to keep the blood glucose level under constant control, whereas the bolus doses help to counteract the increase in levels following food intake/meals

Continuous subcutaneous insulin infusion (CSII or insulin pump therapy)

Description
A regular or continuous amount of insulin (usually a rapid-acting insulin analogue or short-acting insulin) is delivered by a programmable pump and insulin storage device through subcutaneous needle or cannula

Examples of insulin pumps in the UK are MiniMed 640G, Omnipod, A6 TouchCare System, Accu-Chek Combo and DANA Diabecare R

Key points
NICE recommends insulin pump therapy for adults and children 12 years of age or older if:

• Attempts to achieve target HbA1c levels with multiple daily injection therapy result in the person experiencing disabling hypoglycaemia, or
• HbA1c levels have remained high (69mmol/mol or above [8.5% or above]) during multiple daily injection therapy (including, if appropriate, the use of long-acting insulin analogues) despite a high level of care

One, two or three insulin injections per day

Description
These are usually injections of short-acting insulin or rapid-acting insulin analogue mixed with intermediate-acting insulin

Key points
Examples include: 

• Twice daily pre-mixed insulin regimen (human or analogue) for adults with type 2 diabetes or those with type 1 diabetes where the basal-bolus regimen is not possible
• Once daily basal insulin regimen of intermediate or long-acting insulin in addition to appropriate glucose lowering drugs in type 2 diabetes
• Three injections of pre-mixed insulin per day for adults with type 1 or type 2 diabetes