Bolus Insulin and Its Effects

Bolus Insulin

• Bolus insulin is short or rapid-acting insulin used to cover meals (prandial insulin) or to correct high blood sugar.
• Patients with type 2 diabetes may initially use basal insulin, but type 1 patients need both basal and bolus insulin.
• Options for bolus insulin include: Aspart, Lispro, and Glulisine. These are rapid-onset, short-duration insulins.
• Inhaled human insulin and fast-acting insulin aspart (Fiasp) are ultra-rapid onset insulins offering even faster onset than regular insulin.
• Rapid-acting insulins have a lower risk of hypoglycemia than regular insulin. All prandial insulins are effective, but cost varies.

Premixed Insulin Products

• Some premixed insulin products combine basal and prandial insulin components, reducing injections.
• These formulations have fixed mixes, making tailor-made dosing difficult.

Adverse Effects

• Hypoglycemia: Most common side effect.
• Weight Gain: Dose-dependent, primarily truncal fat.
• Injection Site Reactions: Redness, pain, itching, urticaria, edema, inflammation.
• Lipoatrophy/Lipohypertrophy: Fat loss/lumps under skin, preventable by rotating injection sites.
• Respiratory Issues (Inhaled insulin): Cough, upper respiratory infections. Contraindicated in COPD and asthma.
• Pulmonary Function: Inhaled insulin can slightly reduce pulmonary function, requiring baseline and periodic spirometry testing (every 6 months, then annually).

Storage

• Unused insulin should be refrigerated (4°C-8°C).