Chapter-014c Basal Insulin

BOOK TITLE: ESI Manual of Clinical Endocrinology

1. Madhu SV
Publishing Year
Author Affiliations
1. University College of Medical Sciences and GTB Hospital, Delhi, University College of Medical Sciences and G.T.B. Hospital, Delhi, India, University College of Medical Sciences, Delhi, India, UCMS-GTB Hospital Delhi, India; Research Society for the Study of Diabetes in India (RSSDI), UCMS-GTB Hospital, New Delhi, India, Centre for Diabetes, Endocrinology, and Metabolism, University College of Medical Sciences-Guru Teg Bahadur Hospital, New Delhi, India, Center for Diabetes, Endocrinology and Matabolism, University College of Medical Sciences, New Delhi, India
Chapter keywords
Basal Insulin, glycogenolysis, ketogenesis, gluconeogenesis, neutral protamine hagedorn, lente insulin, glargine, degludec, detemir


Insulin is the key method in the treatment of both type 1 and type 2 diabetes mellitus. Basal insulin secretion is mainly used to arrest hepatic glycogenolysis, ketogenesis, and gluconeogenesis. The key features of ideal basal insulin are explained in this chapter. Intermediate-acting insulins NPH (neutral protamine hagedorn) and lente insulin are the two important basal insulins which are given by two doses to cover for a period of 24 hours. Glargine, degludec and detemir are some of the newer basal insulins explained in this chapter. Basal insulin therapy is indicated when blood sugars are not controlled with oral agents or blood sugar levels are poorly controlled. Basal regimen, basal plus regimen, basal-bolus regimen, basal insulin with incretin-based therapy and premixed insulins are types of basal-based regimens. Glargine is most commonly used basal insulin in children and detemir is approved by FDA for children 2 years and above. Role of basal insulin in pregnancy and renal failure, potential carcinogenic risk and future basal insulins are dealt in this chapter.

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