Multiple Daily Injections MDI

MULTIPLE DAILY INJECTIONS, SOMETIMES REFERRED TO AS MDI OR BASAL BOLUS REGIME

Basal – this is your background or base insulin on Multiple Daily Injections.  Basal insulin is provided as a once or twice daily injections of a long-acting insulin.

Bolus – is insulin given with food or for corrections.  Meal (bolus) insulin is administered by injection of rapid-acting insulin before each meal, normally calculated on the amount of carbohydrate content of the meal with your personal requirements.

On an MDI regime, long-acting insulins are preferred for basal use. An older insulin used for this purpose is ultralente, and beef ultralente in particular was considered for decades to be the gold standard of basal insulin.

Now, long-acting insulin analogues such as insulin glargine (brand name Lantus) and insulin detemir (brand name Levemir) are more often used, due to the acidic nature of Lantus it can sting when injected.

Lantus and Levemir have a lot in common. Both are basal insulin formulas, which means that they last for a long time in the body which act as background insulin.

Whether Lantus is better than Levemir, or vice versa, is debatable. Levemir is supposed to be injected twice daily and Lantus once however, some people find better coverage also using Lantus twice daily.  My advice is do your research, is you are not getting good control with one insulin try another.

Rapid-acting insulin analogues such as lispro (brand name Humalog) and aspart (brand name Novolog/Novorapid) and Apidra are preferred by many clinicians over older regular insulin for meal coverage and corrections.

Some people on an MDI regime also use injection ports such as the i-Port Advance to minimise the number of daily injections or to limit a built up of tissue damage and/or lipodystrophy.

Lipodystrophy

Lipodystrophy is an umbrella term that refers to both Lipohypertrophy and Lipoatrophy. This includes a buildup or loss of body fat which appears as lumps or dents in injection sites.  Some people are more prone to Lipohypertrophy and Lipoatrophy than others, the best way to avoid this complication is to only use your needle once and always rotate sites.

It is important that these complications are recognised and managed appropriately. Insulin absorption from these sites is unpredictable and can lead to erratic glycaemic levels, poor control and unpredictable hypoglycaemic attacks. When large areas are involved, it can be cosmetically unsightly and socially embarrassing for patients.

An insulin pump can greatly reduce the amount of daily injections keeping injection sites more healthy.  10 Insertions vs. 120 Injections (Based on typical 30 day period)