It was a normal day in April, nothing new; the sun was as blazing as usual. The streets of Varanasi were filled with a lot of traffic and honking. Everyone was busy with their own work. However, the day was very different from my perspective. I was waiting for my “Report”. No, not my academic results but my Blood Test Report. As my mom is living with Type 2 diabetes, I very well knew the normal range for a person without diabetes. Long story short, My post prandial or simply random blood glucose level was 387 mg/dl. I was shocked! I didn’t know how to react! I felt so alone at that point. Doctor called me inside his chamber and said, “I want to speak to your father. Ask him to visit me in the evening”. That evening, my father came and gave me the first shot of insulin of my life. My doctor prescribed me an insulin called the Human Insulin NPH and Human Insulin Regular. I took it religiously for the next 4 years. Until recently, I moved to Actrapid and Lantus.
The question is what difference does it make? What happened when I changed my insulin? Well, to be more precise, I did not just change my insulin, I changed the entire insulin regimen. I switched from the Mixtard regimen to the Basal Bolus regimen. To know why, keep on reading this blog post.
In the mixtard regimen, the person takes two or three insulin injections per day. Mixtard insulin consists of short-acting insulin or rapid acting insulin analogue in combination with intermediate acting or long-acting insulin. The insulin preparations may be mixed by the person at the time of injection, or a premixed (Mixtard) product can be used. Whereas, the basal bolus regimen consists of a long-acting or intermediate acting insulin that is given by injection subcutaneously (under the skin) once or twice a day with boluses of rapid-acting insulin with meals using an insulin pen or syringe.
There is a humongous difference in the impact of both the regimens. One of the major differences I found was the flexibility of the basal bolus which was missing in the mixtard regimen. Basically, basal bolus therapy aims to mimic the body’s natural profile of insulin secretion consisting of a background (basal) insulin which is a low and steady amount of insulin, even when we are not eating. When we start eating or drinking, bolus insulin is required to maintain the blood glucose in the target goal range in response to the rise in glucose absorbed from food and drink. Mixtard will not give a similar flexibility. If you are on the mixtard regimen you will have to strictly follow the same diet, the same timing of food and the insulin injection.
Young and working masses like us cannot have the kind of control we want with mixtard; we have offices, schools, colleges etc. Due to our schedules, we are not able to follow a strict diet and a strict time table. However, a lot of doctors prefer to prescribe mixtard. The reason is:
- More Economical: What I found while being on a mixtard regimen is that it is cheaper than Lantus, Actrapid etc. So for someone who cannot spend that much or they certainly do not have the resources to buy Actrapid or Lantus, they will prefer mixtard.
- Less Hypoglycemic episodes: If you take more bolus by mistake you can end up in hypoglycemia. Mixtard, as the dosage is set, will not result in a hypo. However, your sugars will not be in range.
To manage Type 1 diabetes well, basal bolus regimen is the best option as it gives you a lot of flexibility and to correct your blood glucose levels even if you are getting hyperglycemia or high blood sugar levels. The major benefits of the basal bolus regimen are:
- Correction Dose: Correction dose is the amount of Insulin that you take to correct your blood glucose level in case of a hyperglycemic episode. It gives you greater control over your Type 1 diabetes management.
- Adjusting your insulin: You can eat whatever you want and adjust the dose according to the carbs present in the food. However, you will have to do a little calculation with some knowledge about insulin and its dosage. Once you learn that, it’s an easy way ahead.
Personally, the Basal Bolus regimen suits my lifestyle and gives a greater flexibility to live my life and enjoy my favourite dishes much better than the Mixtard regimen. Nevertheless, you need to educate yourself to manage your diabetes better whichever regimen you are using. It’s not rocket science- anyone and everyone can learn how to live well with Type 1 diabetes; just a game of learning, understanding and implementing!
– Ankur Mukherjee
He is a Post Graduate in Economics from Varanasi, Uttar Pradesh. He is an alumnus of Banaras Hindu University. He has been living with Type 1 diabetes since 2016. Currently working with The Diabesties Foundation as The Head of Projects Development, and Co-lead of UP Chapter. Moreover, he is also the Mentor of The Blue force Network, which is the youth wing of Diabesties. His only goal is the betterment of his community through education and awareness regarding Type One Diabetes and diabetes in general.