Basal Bolus Insulin Therapy (BBIT) integrates the pharmacology of different insulins to replicate normal physiologic insulin profiles. It aims to anticipate the patient's insulin needs and to decrease both hyperglycemic and hypoglycemic events.
BBIT is a common method of treating diabetes outside a hospital setting, and therefore may be more familiar to patients. BBIT is a mnemonic meant to remind clinicians of the essential steps involved in ordering insulin:
Basal - Long or intermediate acting insulin provided to balance the endogenous glucose produced continuously by the body (gluconeogenesis). Basal insulin mimics the background insulin typically produced by the pancreas 24 hours per day in those without diabetes.
Bolus - Short or rapid acting insulin to balance the carbohydrate intake with meals.
Insulin Correction - Additional short acting insulin used to make small corrections and bring blood glucose back to target, if needed.
Titrate - Ensure that blood glucose is monitored 4 times daily and that insulin doses are adjusted to meet Diabetes Canada targets of 5-10 mmol/L.
Our ultimate objective is to promote safe and effective diabetes management in hospital by focusing on the implementation of best practice through clinical education, quality improvement and knowledge translation.
The BBIT website is one tool to support the update of basal bolus insulin therapy to assist patients with diabetes in achieving their blood sugar targets while in hospital. It is currently being used by frontline providers across the country and beyond.