Triple‐B (basal‐bolus‐booster) subcutaneous insulin regimen: a pragmatic approach to managing hospital inpatient hyperglycaemia

Abstract

AbstractThe objective of this study was to introduce a practical insulin protocol for hospital inpatients with hyperglycaemia.The acronym BBB emphasised the insulin supply in three components, basal, bolus (nutrition correction) and booster (blood glucose level [BGL] correction). The insulin dosage was based on patient weight and adjusted to BGL at pre‐specified times. Compliance of BGL measurements and insulin injections, and efficacy were evaluated prospectively. Fifty‐seven hospital inpatients with significant hyperglycaemia were treated and compared with 45 historical controls (with similar age, HbA1c and diabetes duration) treated with sliding scale insulin (SSI).The BGL (mean±SD) was significantly lower during BBB treatment (11.7±2.6 vs 13.6±2.4mmol/L; p<0.0001), while episodes of hyperglycaemia were less (median: 3 [IQR 1–8] vs 7 [IQR 4–12]; p=0.001). Patients who experienced hypoglycaemia were also less likely to have a repeat episode with the BBB protocol (median: 1 [IQR 1–3] vs 3 [IQR 2–4.5]).The BBB protocol is easy to implement and resulted in significant improvement in BGL control compared with SSI. Copyright © 2011 John Wiley & Sons.