Basal Bolus Insulin Therapy (BBIT) is a way of ordering multiple daily injections of subcutaneous (sc) insulin that better replicates how our body naturally produces insulin. It aims to keep the hospitalized patient’s blood sugars within the target range of 5-10 mmol/L.
The use of "sliding scale" insulin, although still common, treats high blood sugar after it has occurred. Traditional sliding scale insulin treatment is not individualized, and can result in greater blood sugar fluctuation throughout the day.
Basal Bolus Insulin therapy allows clinicians to customize insulin regimes based on the unique needs of each patient. It is proactive, and aims to anticipate patient's insulin needs. It prevents blood sugar highs and lows, so the patient feels much better. BBIT has been shown to be an effective way to manage patients’ diabetes during their hospital stay, and is more similar to how patients with diabetes manage their blood sugars in the community.
BBIT includes 3 components: basal insulin (long acting), bolus (short acting or meal-time) insulin, and correction insulin. A provincial order set for Basal Bolus Insulin Therapy has been created. Its implementation will be accompanied by interdisciplinary education and a new blood sugar record.
It’s more than just an order set!
The provincial team will support the site champions at the self-identified early adopter sites to implement BBIT at their site, using a knowledge translation (putting knowledge into action) strategy. The implementation plan will focus on known barriers and facilitators of this change in practice. It includes: site readiness for change, site based champions (MD, Nursing, Pharmacy) leading the change supported by an administrative champion, data, ongoing profession specific education, elimination of pre-printed sliding scale orders, and linking the blood glucose results to the insulin orders—so that the insulin dose can be titrated to achieve the blood sugar targets.
Early adopter sites will collect baseline data, so they can monitor process and outcomes for their patients, after introducing the new way of ordering subcutaneous insulin.
The DON SCN has supported a number of sites in their implementation including: Chinook Regional in Lethbridge, Calgary Zone rural sites (7), Calgary Zone urban sites (Foothills, Peter Lougheed, Rockyview, and South Health Campus), University Hospital and Covenant Grey Nuns Hospital in Edmonton.
For more information about BBIT, and resources to support implementation at your site; please visit: www.bbit.ca
For more information about Knowledge Translation, we invite you to view the following recorded webinars:
Basal Bolus Insulin Therapy Webinar
Presented by Dr. Karmon Helmle (Endocrinologist in Calgary Zone and Clinical Assistant Professor in the Division of Endocrinology and Metabolism at the University of Calgary) and Isabelle Emery (Patient Advisor, DON SCN) (Webinar, presentation can be downloaded from this webinar site.)