Basal Insulin: What is it? Differences, Choice, Considerations, Potential Benefits, Dosage and Side Effects

It is a type of therapy, if you need this insulin, it is important to understand how it works and how it differs from other types of the drug.

Your body needs insulin to function properly, and the correct dose of basal insulin may be the answer to stabilize your blood sugar level and avoid the complications of diabetes.

Insulin is a hormone that everyone needs. It allows the body to use sugar (glucose) properly. But if you have type 1 diabetes or type 2 diabetes, your body does not make or use insulin properly, which means you may need to take insulin injections on a daily basis.

Insulin is not one size fits all. There are different insulins that you can use to control your blood sugar levels, and they are rated by how quickly they work.

The main job of basal insulin is to keep your blood glucose levels stable during periods of fasting, such as when you are sleeping. While you are fasting, your liver continually secretes glucose into your bloodstream. Basal insulin keeps these glucose levels in check.

Without this insulin, your glucose levels would rise at an alarming rate. Basal insulin ensures that your cells are fed a constant stream of glucose to burn energy throughout the day.

Here’s what you need to know about basal insulin medication and why it is important for managing diabetes.

What is basal insulin and how can it help control diabetes?

Basal insulin is an important component in managing diabetes because it acts as a background insulin. It is designed to stabilize blood sugar during periods of fasting, such as between meals and while you sleep.

Insulin also plays a role in the way you metabolize carbohydrates. After you eat, your body breaks down carbohydrates in food into sugar or glucose to energize your body and allow you to walk, eat, perform tasks at work, and more.

This breakdown increases the level of sugar in the blood, and in response to this higher level, the pancreas releases insulin into the bloodstream.

Insulin helps your body’s cells absorb glucose into your bloodstream, providing you with that essential energy. Some of the glucose that remains in the blood is stored in the liver and is then slowly formed and released into the bloodstream when there is a demand for fuel.

Because people with type 1 diabetes do not make their own insulin, they must receive basal insulin injections to control their blood sugar level. But if you have type 2 diabetes, your body still makes insulin.

The problem is that your pancreas may not make enough insulin to maintain a healthy glucose level. This is why your doctor may recommend the use of basal insulin at some point in your treatment. Between 75 and 90 percent of people with type 2 diabetes require injections.

Basal insulin is slowly absorbed and long-lasting, which helps keep your blood sugar level stable when your liver releases extra glucose.

What is the difference between basal and bolus insulin?

Along with basal insulin, bolus insulin is a treatment option for type 2 diabetes.

While basal insulin works as background insulin to deliver insulin to your body during periods of fasting, bolus insulin (or during mealtime) is a fast-acting insulin that works quickly, but there is a catch: its hypoglycemic effect. it doesn’t last that long.

Bolus insulin is taken at mealtime, about 10-15 minutes before eating, and can control blood sugar for about three to six hours. These insulins include:

Humalog (lispro)

Humalog is the brand name for a fast-acting insulin called insulin lispro. Humalog Mix 75/25 and Humalog Mix 50/50 contain mixtures of insulin lispro along with a second form of insulin called protamine lispro.

Humalog is a medicine used to treat both type 1 and type 2 diabetes.

NovoLog (aspart)

NovoLog is the brand name for the prescription drug insulin aspart, which is used to treat diabetes. It is a short-acting, manufactured version of human insulin that reduces sugars in the blood.

The medication works by replacing the insulin that the body normally produces, which helps move sugar from the blood to other areas of the body and prevents the liver from making more sugar.

If you have type 1 diabetes, you will likely use NovoLog with another type of insulin, unless it is used in an external insulin pump.

In people with type 2 diabetes, NovoLog can be used with another type of insulin or with oral diabetes medicines.

Apidra (glulisina)

Insulin glulisine is a fast-acting insulin that starts to work about 15 minutes after injection, peaks in about 1 hour, and continues to work for 2 to 4 hours.

It is used to improve blood sugar control in adults and children with diabetes mellitus. Insulin glulisine is used to treat type 1 or type 2 diabetes in adults and type 1 diabetes in children who are at least 4 years old.

Humulin R (regular)

Humulin R is a brand name for a medicine that contains regular insulin (a short-acting form of insulin).

Insulin is a hormone produced by the body in the pancreas. It works to lower blood sugar levels.

This prescription medicine is injected to improve blood sugar control in adults with diabetes.

When to consider using basal-bolus insulin for blood sugar control

If you have type 1 diabetes, you will need a combination therapy called basal-bolus insulin. This therapy includes an injection of rapid or rapid-acting insulin before meals, as well as a daily injection of basal background insulin.

Because your body does not produce insulin, it is key to work with your doctor to come up with an effective treatment approach.

Does living with type 2 diabetes mean you have to take insulin?

Not always, many people living with type 2 diabetes may not need basal insulin, or at least not right away.

Because your body can still make insulin, changes in diet, physical activity, and oral medications can help your body overcome insulin resistance and use insulin properly.

Losing weight and adding 30 minutes of regular physical activity five days a week can help your body respond to its own insulin so that your cells can absorb glucose naturally.

You can also help improve your body’s response to its own insulin by eating less starch and sugary foods, and by eating more low-calorie foods like fruits and vegetables.

Your doctor may also prescribe the oral medication Glucophage ( metformin ), which helps control high blood sugar by limiting the amount of sugar made by the liver.

If diet, lifestyle changes, and medications are not enough to control your blood sugar, you may need to consult your doctor about basal insulin in your treatment regimen.

Signs that you may need insulin therapy include:

  • Increased thirst.
  • Frequent urination
  • Blurry vision.
  • Fatigue.

Keep in mind that these mimic the early signs and symptoms of diabetes.

Basal Insulin Choice: Which Type Is Best For You?

There are three types of basal insulins available to help control your blood sugar, and you can work with your doctor to determine the best type and dose for you.

The types of basal insulin include:

Intermediate-acting insulin

NPH: Humulin N (isophane) and Novolin N:

Branded versions include Humulin and Novolin. This insulin is given once or twice a day. It is usually mixed with insulin during lunch in the morning, before dinner, or both.

It works hardest in 4 to 8 hours after injection, and the effects start to wane after about 16 hours.

Long-acting insulin

Two types of this insulin currently on the market are detemir (Levemir) and glargine (Lantus). This basal insulin starts working 90 minutes to 4 hours after injection and stays in the bloodstream for up to 24 hours.

It can start to weaken a few hours earlier for some people or last a few hours longer for others. There is no peak time for this type of insulin. It works at a constant rate throughout the day.

Lantus (glargine or Toujeo) and Basaglar:

  • Injected once a day and active two hours after injection.
  • It lasts between 20 and 24 hours.

Detemir (levemir):

  • Injected once or twice a day and active two hours after injection.
  • It lasts between 14 and 24 hours.

Long-lasting insulin

In January 2016, another basal insulin called degludec (Tresiba) was released. This basal insulin starts working within 30 to 90 minutes and stays in the bloodstream for up to 42 hours.

As with the long-acting insulins detemir and glargine, there is no peak time for this insulin. It works at a constant rate throughout the day.

Tresiba (degludec):

Insulin degludec is available in two strengths, 100 U / ml and 200 U / ml, so be sure to read the label and follow the directions carefully. Unlike detemir and glargine, it can be mixed with other rapid-acting insulin that may hit the market soon.


When deciding between intermediate and long-acting basal insulins, there are many factors to consider. These include your lifestyle and willingness to inject.

For example, you can mix NPH with insulin during a meal, while long-acting basal insulin must be injected separately.

Factors that can affect your insulin dose include your body size, hormone levels, diet, and the amount of internal insulin your pancreas still produces, if any.

Potential benefits of using basal insulin

Basal insulin is used by many people with diabetes because it helps them better control their blood sugar levels between meals, and allows a more flexible lifestyle.

For this reason, some people prefer basal insulin, because it provides greater flexibility. Unlike mealtime insulin, which must be taken before each meal, basal insulin should be injected only once or twice a day.

For example, if you use long-acting insulin, you don’t need to worry about spikes in insulin activity. This means that the timing of meals can be more flexible. It can also reduce your risk of low blood sugar levels.

Because this insulin is long-acting, you don’t have to schedule your injections around meals, and it can keep your blood sugar level stable for longer periods of time.

If you have a hard time maintaining your blood sugar levels in the morning, adding basal insulin to your dinner or bedtime regimen can help solve this problem.

A quick guide to help you inject your basal insulin

Basal insulin requires a daily injection. Options include an insulin pen with a pre-filled cartridge that contains your insulin dose or a syringe that fills with the prescribed dose in an insulin bottle.

Insulin doses vary, and your doctor will determine how much insulin you need to control your diabetes.

Insulin is not injected into the muscles or veins, but into the tissue under the skin. Your doctor will show you how and where to administer your doses.

You will most likely inject insulin into your abdomen so that it can be rapidly absorbed into your bloodstream. Insulin injected into the arm or thigh takes longer to reach the bloodstream.

Wash your hands and clean the injection site with alcohol before injecting. Grab or pinch a fold of your skin, and then inject the needle at a 90-degree angle. If you are thin, you may need to inject the needle at a 45 degree angle.

Make sure to rotate your injection site. If you inject insulin in the same place every day, fat deposits may develop in this area and reduce insulin absorption.

It is also important that you do not reuse or share your needles with anyone, and you must ensure that your insulin is stored properly and does not expire.

An insulin pump may be an option if you take basal insulin along with a rapid-acting insulin before meals.

This is a small device that delivers insulin 24 hours a day, based on your body’s needs. Insulin enters your body through an attached catheter under your skin.

Dose and fine-tune your basal insulin regimen

The dose of intermediate-acting, long-acting, and ultra-long-acting insulin you receive is based on your lifestyle and your body’s insulin needs.

When you start taking insulin injections, your doctor may prescribe one injection per day based on your weight, and then adjust or adjust your dose later.

If you are new to basal insulin, your doctor will probably start your dose at 10 units per day at bedtime, although many people require between 40 and 50 units.

Make sure to check your blood sugar levels before and after going to bed. Ideally, your glucose level should rise or fall by no more than 30 milligrams per deciliter (mg / dl) while you sleep.

Any major or minor change could indicate the need to adjust your insulin dose. Talk to your doctor to determine the correct amount of insulin.

Some people must use a combination of insulins to control their blood sugar level. You cannot mix determir, glargine, or degludec with fast-acting insulins.

NPH can be mixed with fast-acting insulins and can actually be prescribed in a premixed container. This includes 70 percent of NPH insulin with 30 percent of a regular insulin (Humulin R), or your doctor may prescribe NPH with Humalog or NPH with NovoLog.

Dosage information

With basal insulin, you have three dosing options. Each option has pros and cons. Everyone’s basal insulin needs are different, so your doctor or endocrinologist can help you decide which dose is right for you.

Take NPH at bedtime, in the morning, or both

This approach can be valuable because insulin peaks during the early morning and evening, when it is most needed. But that spike can be unpredictable based on your meals, meal timing, and activity level.

This can lead to low blood sugar levels while you sleep or low or high blood glucose levels during the day.

Taking detemir, glargine, or degludec at bedtime

The continuous flow of these long-acting insulins is one of their main advantages. However, some people find that the insulin detemir and glargine disappear within 24 hours of the injection.

This can mean higher blood glucose levels at your next scheduled injection. Degludec should last until your next scheduled injection.

Using an insulin pump

With an insulin pump, you can adjust your basal insulin rate to match your liver function. One disadvantage of pump therapy is the risk of diabetic ketoacidosis due to pump malfunction.

Any minor mechanical problem with the pump can cause you not to receive the correct amount of insulin.

Possible side effects of basal insulin

It is important to take the proper dose of basal insulin to prevent blood sugar levels from plummeting, causing hypoglycemia (low blood sugar). This can happen if you take too much insulin.

Some potential side effects associated with basal insulin include hypoglycemia and possible weight gain, although to a lesser degree compared to other types of insulin.

Signs of hypoglycemia include:

  • Confusion.
  • Instability.
  • Fast heartbeat
  • Headache.
  • Seizures

If you have these symptoms, eat a few cookies or a hard candy to help reverse the condition.

There is also a risk of developing an allergic reaction at the injection site. Signs of a reaction include itching, redness, and swelling. If you are allergic to insulin, you may experience nausea and vomiting.

Certain medications, including beta-blockers, diuretics, clonidine, and lithium salts, can weaken the effects of basal insulin. Talk to your doctor and endocrinologist about the medications you are currently taking and about any dangerous interactions with other medications.

See your doctor if you experience hypoglycemia or signs of an allergic reaction. Your doctor may need to adjust your dose or prescribe a different type of insulin.

Insulin is essential to energize your body. Basal insulin is a crucial component in your diabetes management. Work with your doctor or endocrinologist to determine which type is best for you and your needs.

If your body does not produce insulin or uses insulin properly due to type 1 or type 2 diabetes, basal injections can help stabilize blood sugar and reduce the likelihood of diabetes complications such as kidney damage, eye damage, damage to nerves and heart problems.

Be sure to follow your doctor’s instructions and take your insulin as prescribed. If you feel like your insulin is not working effectively, talk to your doctor about adjusting your dose.