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

The 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.