Reduced Basal Insulin Needs?

[GrantGam]

Hello all,

I have noticed that I require a lot less basal insulin (Levemir) of late. I was on around 32 units, split dose (both 16u). Now I'm down to 14u, 7u split dose and I'm still experiencing hypos during the day and also during the night (according to the Libre).

Over the past two weeks or so I've been reducing my carbohydrate content to somewhere around <80g per day. Since doing this I have not increased my activity levels in any way. I've lost a bit of weight, maybe 2kg since dropping the carbs down - but this surely wouldn't account for this reduction in basal insulin? I was under the impression that reducing carbohydrate intake shouldn't affect your basal requirements, only bolus?

I have been T1D for a little over two years now and have not been taking such a little amount of insulin since about 2 months after diagnosis.

Has anyone any ideas or possible reasons as to why my basal requirements are going down rather than up? Considering that any honeymoon period should be well over by now.

Also, is anyone aware of a rough estimate as to how much basal you should be using? I know everyone has different needs but I'm sure there's some sort of unit/kg calculation?

Cheers guys,
Grant

 

[Daibell]

Hi. If you search the web you will find guideline Basal/Kg calculations for new starters. I find when I increase my carbs on holiday I need to increase my Basal apart from the weight ratio thing so there is a connection.

 

[tim2000s]

It is totally down to you reducing carbs. Most of us are affected by that.


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[noblehead]

Has anyone any ideas or possible reasons as to why my basal requirements are going down rather than up? Considering that any honeymoon period should be well over by now.

Certainly losing weight can reduce your basal needs, but if these changes have only come about since starting your low-carb diet then it must be that @GrantGam1337

However basal needs do change over time, around 10 years ago I was injecting 36 units and up until starting on a pump last year I was down to 18-20u, currently around 16u

 

[robert72]

Over the last few weeks I have dropped from 16u basal to 11u. I'm pretty sure it's due to the warmer weather.

 

[Kristin251]

My basal needs changed about a year after diagnosis. You are probably also becoming more insulin sensative. Warm weather makes a difference, exercise, carbs, blood sugars during the day as well as other things.
I started on 5 units lantus and now 1. If I'm over 115 at bed I take 2. I keeps me very flat and two will drop me a bit.

 

[GrantGam]

Hi. If you search the web you will find guideline Basal/Kg calculations for new starters. I find when I increase my carbs on holiday I need to increase my Basal apart from the weight ratio thing so there is a connection.

Hi and thanks,

I've tried searching on a few occasions and the only thing I can find is Levemir wrt T2D. I'm nearly sure I've seen a graph somewhere before...

I have found this however, seems to make sense - any views on this information?

 

[GrantGam]

Certainly losing weight can reduce your basal needs, but if these changes have only come about since starting your low-carb diet then it must be that @GrantGam1337

However basal needs do change over time, around 10 years ago I was injecting 36 units and up until starting on a pump last year I was down to 18-20u, currently around 16u

Thanks,

@noblehead, @tim2000s - Providing it's diet related then that's fine. I always assumed basal wasn't affected by diet as that was the QA insulin's job. My mistake...

 

[GrantGam]

My basal needs changed about a year after diagnosis. You are probably also becoming more insulin sensative. Warm weather makes a difference, exercise, carbs, blood sugars during the day as well as other things.
I started on 5 units lantus and now 1. If I'm over 115 at bed I take 2. I keeps me very flat and two will drop me a bit.

Many thanks for your feedback

 

[GrantGam]

Over the last few weeks I have dropped from 16u basal to 11u. I'm pretty sure it's due to the warmer weather.

Cheers, wish it was warmer in Scotland though

 

[Cragwood]

I saw a calculation on here of 0.53 x your weight in kg as total insulin, both basal and bolus. Hope that helps x

PS I'm taking less than that calculation would work out (about 10u less per day), but I'm type 2 so probably still producing some insulin. Similarly if you had a very active job your requirements might be less.

 

[GrantGam]

I saw a calculation on here of 0.53 x your weight in kg as total insulin, both basal and bolus. Hope that helps x

PS I'm taking less than that calculation would work out (about 10u less per day), but I'm type 2 so probably still producing some insulin. Similarly if you had a very active job your requirements might be less.

Thanks a lot, will take some messing around to get this back in check. Especially if I plan to keep my carbs down as I'm currently doing.

Regards,
Grant

 

[Cragwood]

Thanks a lot, will take some messing around to get this back in check. Especially if I plan to keep my carbs down as I'm currently doing.

Regards,
Grant

I've had to reduce my basal as I've reduced my carbs, but again I'm not type 1. As you say, you will have to mess about until you find the right balance for you. Good luck!

 

[robert72]

I had to reduce basal as I reduced carbs. I suppose less glucose is stored/released for background tasks when running on ketones.

 

[GrantGam]

As you've all suggested, it would make sense for a lesser basal dose with respect to a lower carb intake and it definitely appears to be the case.

I must be misunderstanding the rough calculations that I've been reading online. Many suggest that between 40-50% of the total daily insulin requirement should be basal insulin.Lets say 0.5 x 73kg = 36.5u. 50% of my TDIR would be 18.25u of Levemir. So if I ate 80g of carbs per day working on a 1:10 ratio; I'd still have roughly 10u of insulin needs unaccounted for?

I understand that diabetes isn't an exact science but I'm struggling to see what the purpose of a 'total daily insulin requirement' is if it doesn't really add up? According to my shoddy maths anyway.

 

[robert72]

Those formulae are only useful as a starting point - ultimately, you need the amount of basal and bolus that works for you.

 

[Kristin251]

The calculation of .53 per kg would mean I should take 29 units of insulin. I take 1/2 at meals ( 1.5 total) and 1 lantus so 2.5 units basal/ bolus. I would be dead if I took 29. Unless I did math wrong. 120 pounds = 54.5 kg x .53 = 28.8

There are far too many variables

 

[GrantGam]

The calculation of .53 per kg would mean I should take 29 units of insulin. I take 1/2 at meals ( 1.5 total) and 1 lantus so 2.5 units basal/ bolus. I would be dead if I took 29. Unless I did math wrong. 120 pounds = 54.5 kg x .53 = 28.8

There are far too many variables

I'm glad those calculations are just a generic approach. I will ignore the apparent "rule of thumb" and keep tweaking my basal until it's sorted out

Many thanks!

 

[noblehead]

I understand that diabetes isn't an exact science but I'm struggling to see what the purpose of a 'total daily insulin requirement' is if it doesn't really add up? According to my shoddy maths anyway.

The 50/50 ratio for TDD is only a rough guide, many things can effect the balance like exercising and eating (as you've found out yourself).

Knowing your TDD is useful when working out your correction factor (CF), again this is just a rough guide but most find it isn't too far away, also knowing what your TDD is comes in handy when your ill and following the Sick Day Rules for insulin users.