Advise on basal

[ronialive]

Hi I was looking for some advise. My diabetic nurse changed my basal rates as she said that the balance was wrong. She said I have too much basal and not enough bolus. I disagreed but she said I had to change.
In my mind and how it was explained the basal keeps your sugars stable and runs in the background where as your bolus deals with food. So there can be no right or wrong as it will depend on what you eat. I don't eat that much carbs.

I have just done another basal testing and fasting run and at 7 am this morning I was 4.2. the graphs shows I climbing higher and higher and currently is 9.8 at 2pm.
To me this says that my basal is too low.
she has insisted that it is right and the bolus needs adjusting.
Is it me?????? has she lost the plot or is there new info that I am not aware of???
I am going to buy the libre system as I cant bear this and am concerned they will stop funding my pump when I have had virtually no support and then advise like this.

Thanks

 

[Juicyj]

Hi Roni,

I agree, are you sure your nurse hadn't got the two confused ? Can you ask her to justify this decision ?

If your rising and have no carbs on board then your basal needs to be reviewed, if you are rising after food and continue to stay high then your bolus ratio needs a tweak. Do remember you are the expert on your diabetes, if you don't feel comfortable then either ask her to justify or get a second opinion, do you normally make changes yourself ?

 

[ronialive]

Hi Roni,

I agree, are you sure your nurse hadn't got the two confused ? Can you ask her to justify this decision ?

If your rising and have no carbs on board then your basal needs to be reviewed, if you are rising after food and continue to stay high then your bolus ratio needs a tweak. Do remember you are the expert on your diabetes, if you don't feel comfortable then either ask her to justify or get a second opinion, do you normally make changes yourself ?

I have always made the changes myself and asked for help as my hormone levels are having drastic affects and I wanted to set up 4 different basal rates for each week of the month. I have only just started seeing them- and she was adamant that I was wrong.
Just started to doubt myself and wanted to run it past others that I am not mad. Gonna look up previous dose and change it back and work from there and use the libre to help with the rest.
Thank you for the reassurance.

 

[Juicyj]

I understand exactly what you mean it would give you self doubt, ultimately your nurse, although trying to help, does not live with the condition

 

[noblehead]

I have just done another basal testing and fasting run and at 7 am this morning I was 4.2. the graphs shows I climbing higher and higher and currently is 9.8 at 2pm.
To me this says that my basal is too low.

Possibly, possibly not @ronialive

Some of us find when we don't eat on a morning we experience a liver dump that pushes bg up, in your example my bg levels would be in double figures by 2pm, tbh basal testing on a morning is by far the hardest test to perform for that very reason.

However, the idea that the ratio for basal/bolus should be 50/50 is wrong, as you've already said the amount of carbs consumed would effect the balance as would activity (with exercise I can reduce my bolus doses by 50%), so as long as your bg levels are under control and your not having hypo's then I wouldn't worry too much about the balance of the two.

 

[ronialive]

Possibly, possibly not @ronialive

Some of us find when we don't eat on a morning we experience a liver dump that pushes bg up, in your example my bg levels would be in double figures by 2pm, tbh basal testing on a morning is by far the hardest test to perform for that very reason.

However, the idea that the ratio for basal/bolus should be 50/50 is wrong, as you've already said the amount of carbs consumed would effect the balance as would activity (with exercise I can reduce my bolus doses by 50%), so as long as your bg levels are under control and your not having hypo's then I wouldn't worry too much about the balance of the two.

would that still apply if you eat but not carbs and if so why do they get us to do it? I have eaten chicken and prawns but drank water only. Basal was great before they changed the insulin. I was just working on insulin ratio to extra iinsulin and carb ratio at lunch and tea then was sorted- now it is just a mess

 

[iHs]

@ronialive

Since switching to a lower carb diet (120g now down to about 50g), I tend to need more basal and even though my bolus has dropped, it could look as though I'm a bit lop sided. If I was to eat more carb in my diet, my basal would drop a bit to keep in line with the more bolus resulting in a 50/50 balance more or less. Regardless of how much basal someone uses or how much bolus, everything boils down to the effect of how the combination of the insulin together, has on controlling bg levels. If bg is ok, then no need to change. My hormones also change so I have times when I need to either adjust the basal or if that doesn't work the way I want it to, I adjust the bolus or adjust the carb. Usually after a day or so, I get there until the next time.......

 

[donnellysdogs]

I would do readings an hour after getting up and two hour and three hour... Without eating.

I think you need to dona basal test for mornings, afternoons and evening....

 

[noblehead]

would that still apply if you eat but not carbs and if so why do they get us to do it? I have eaten chicken and prawns but drank water only. Basal was great before they changed the insulin. I was just working on insulin ratio to extra iinsulin and carb ratio at lunch and tea then was sorted- now it is just a mess

It depends on whether protein puts your bg up without bolusing for it, if I eat a very low-carb breakfast like bacon & eggs/cheese omelette I need nearly as much insulin as I do for my usual breakfast of porridge.

You may not experience a liver dump in a morning when you don't eat and it could be that your basal rate needs increased, I was just offering an opinion before based on my own experience @ronialive.

 

[ronialive]

thanks for all the advice- I shall put it back to where it was and keep working on it. I do think as a new nurse she was just trying to show she is there. I have always been heavy on the bolus insulin and lopsided with much higher amounts needed in am compared to pm. I guess I just don't fit into her box.

 

[donnellysdogs]

Do you basal test though?

 

[iHs]

Hi I was looking for some advise. My diabetic nurse changed my basal rates as she said that the balance was wrong. She said I have too much basal and not enough bolus. I disagreed but she said I had to change.
In my mind and how it was explained the basal keeps your sugars stable and runs in the background where as your bolus deals with food. So there can be no right or wrong as it will depend on what you eat. I don't eat that much carbs.

I have just done another basal testing and fasting run and at 7 am this morning I was 4.2. the graphs shows I climbing higher and higher and currently is 9.8 at 2pm.
To me this says that my basal is too low.
she has insisted that it is right and the bolus needs adjusting.
Is it me?????? has she lost the plot or is there new info that I am not aware of???
I am going to buy the libre system as I cant bear this and am concerned they will stop funding my pump when I have had virtually no support and then advise like this.

Thanks

Hi

Looking at yr msg, it looks as though yr 7am bg of 4.2mmol could do with being a bit higher (6mmol ?) so probably the 5am basal rate needs lowering but it might also be that the 3am basal also reveals a bg of 4mmol so in many ways, it pays to look about 5hrs in advance to make sure that the correct basal rate time is adjusted first before adjusting others. If you look at all the bg levels after the 7am one to see the time when bg starts to go upward, you should be able to get the bg ok again by adjisting the basal upwards, so it looks as though you need less basal early morning, then more basal as the morning continues to afternoon. Once the basal appears ok with bg fasting, its then time to try to sort out the bolus

 

[donnellysdogs]

What sort of basal / bolus ratio were your old settings?

I think you really need to do hourly basal tests....