Basal/Bolus

SueJB

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I know that bolus insulin works on the food eaten. My question is, what does basal do?
 

librarising

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Help keep you alive, or at least avoid high blood sugar damage.
The bodies produces various substances, without which you'd be dead, such as blood, cholesterol, insulin.
All Dawn Phenomenon sufferers know that the body has a useful facility to put glucose into the blood stream when necessary, at various times of the day. This happens even in the absence of food, so a T1D, with little to no self-produced insulin (just like some T2Ds), has to compensate for this by injecting a long-lasting basal. Basal at the correct dose helps produce a stable blood sugar level, where correctly dosed boluses then do the same for food intake.
When the body works as intended, it's a little miracle machine :)
Geoff
 

catapillar

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Whether or not you are eating your liver trickles out its glucose stores through the day and night to keep you going. Without insulin that released trickle of glucose just sits in the blood and can't do anything to keep you going because it can't get into the cells, instead it just slows you down with high blood sugar. Other things that increase blood sugars without food through the day would be things like your circadian rhythm waking you up with a more substantial glucose release from the liver along with some helpful wake up hormones that make you resistant to insulin.

The job of the basal insulin is to keep your blood sugars flat-ish when you aren't eating or taking basal. It deals with your body's natural keep you going processes that you don't have the insulin to deal with anymore.
 

Hareph

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Basal is a word derived from base. It's the lowest level something runs at, it's like the tickover rate of a car engine.
 

SueJB

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Whether or not you are eating your liver trickles out its glucose stores through the day and night to keep you going. Without insulin that released trickle of glucose just sits in the blood and can't do anything to keep you going because it can't get into the cells, instead it just slows you down with high blood sugar. Other things that increase blood sugars without food through the day would be things like your circadian rhythm waking you up with a more substantial glucose release from the liver along with some helpful wake up hormones that make you resistant to insulin.

The job of the basal insulin is to keep your blood sugars flat-ish when you aren't eating or taking basal. It deals with your body's natural keep you going processes that you don't have the insulin to deal with anymore.
Thanks @catapillar that's very clearly explained. Not sure if you can answer this but have a go. If the basal dose is too low, might that account for waking with a high FBG?
 

Juicyj

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Hi @SueJB What are your nighttime levels like ? Do you have any quick acting in your system before bed time ? Also what basal are you on and do you split ? I call basal the background insulin as it covers the bases, the quick acting is the top up for carbs and corrections.

The easiest way to check your basal dose is to ensure your quick acting insulin is depleted before bedtime, so eat early evening, test before bed and then wake at 2am and do a test, if you running high at this point then it would point to a basal adjustment.
 

SueJB

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Hi @SueJB What are your nighttime levels like ? Do you have any quick acting in your system before bed time ? Also what basal are you on and do you split ? I call basal the background insulin as it covers the bases, the quick acting is the top up for carbs and corrections.

The easiest way to check your basal dose is to ensure your quick acting insulin is depleted before bedtime, so eat early evening, test before bed and then wake at 2am and do a test, if you running high at this point then it would point to a basal adjustment.
Thanks, you certainly know your stuff which is great.
I do split basal 50/50 7am and 7pm. To be honest, I don't generally test before going to bed so I don't know. I eat around 7pm usually. When I have tested before bed, I generally make sure it's around BG is 6mmols, no higher or lower.
When you say "running high" do you say an approx figure?
Here's another thing, I haven't had to do any bolus for 2 weeks.
 

Juicyj

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Thanks, you certainly know your stuff which is great.
I do split basal 50/50 7am and 7pm. To be honest, I don't generally test before going to bed so I don't know. I eat around 7pm usually. When I have tested before bed, I generally make sure it's around BG is 6mmols, no higher or lower.
When you say "running high" do you say an approx figure?
Here's another thing, I haven't had to do any bolus for 2 weeks.

Hi Sue, it's a good idea to test before bed, personally my evening routine consists of eating early so by bedtime (approx 3.5 hours later) any quick acting is out of my system then test before bed, correct with quick acting if necessary and then test upon waking - I try to ensure my bedtime reading and waking result are within around 1mmol/l of each other which tells me my background insulin dose is fine. If i was waking at 2am to do a night time test and was running above 9mmol/l then I would consider this high and would warrant taking a correction dose for, particularly if my bedtime reading was in range at say 6mmol/l, however on an ongoing basis I would also increase my basal dose too to prevent this from continuing.

As you've not taking a bolus for 2 weeks how are you correcting if you're running high ? and what are your daytime readings like ?
 
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slip

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Just to add to juicyj excellent post above, don't just change your basal dose based on 1 nights results, and wait at least 3 days/nights after adjusting basal to make another change.

Sorry Sue couldn't remember how long you've been diagnosed, it is possible to have some good numbers without taking bolus insulin while you're still in the honeymoon period.
 

SueJB

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Hi Sue, it's a good idea to test before bed, personally my evening routine consists of eating early so by bedtime (approx 3.5 hours later) any quick acting is out of my system then test before bed, correct with quick acting if necessary and then test upon waking - I try to ensure my bedtime reading and waking result are within around 1mmol/l of each other which tells me my background insulin dose is fine. If i was waking at 2am to do a night time test and was running above 9mmol/l then I would consider this high and would warrant taking a correction dose for, particularly if my bedtime reading was in range at say 6mmol/l, however on an ongoing basis I would also increase my basal dose too to prevent this from continuing.

As you've not taking a bolus for 2 weeks how are you correcting if you're running high ? and what are your daytime readings like ?
Hi
All my day time readings have been between 4-6.5mmols so not correction needed
 

tinyfilosofer

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Thanks @catapillar that's very clearly explained. Not sure if you can answer this but have a go. If the basal dose is too low, might that account for waking with a high FBG?

A basal of 9 keeps me flat at 6mmol throughout the night but when I wake up it goes up to 9

If i dose 10, I drop frequently in the night. To be safe, I dose 9.

When I wake up in the morning, I bolus immediately.

Best to be safe than to force a Low reading. You need to be alive as priority.
 
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tinyfilosofer

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Basal requirement is different at different period of the month. Wear a cgm for at least a while to know your cycle better.
 

SueJB

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A basal of 9 keeps me flat at 6mmol throughout the night but when I wake up it goes up to 9

If i dose 10, I drop frequently in the night. To be safe, I dose 9.

When I wake up in the morning, I bolus immediately.

Best to be safe than to force a Low reading. You need to be alive as priority.
I suppose I'm still on honeymoon so my basal dose is tiny, practically insignificant 3mmols. When I do test before bed I like a 6 and my FBG is 5 or 6 so this morning was a manic shock at 8.7. I haven't had to bolus for 2 weeks now because of low carb. I had to at lunch as I was eating out
 

tinyfilosofer

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I suppose I'm still on honeymoon so my basal dose is tiny, practically insignificant 3mmols. When I do test before bed I like a 6 and my FBG is 5 or 6 so this morning was a manic shock at 8.7. I haven't had to bolus for 2 weeks now because of low carb. I had to at lunch as I was eating out

It’s ok to be high for a bit in the morning. Just bolus and breakfast as soon as you can. Stay safe at night as priority. Hugs and stress can kill faster than high sugar!!!
 

SueJB

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It’s ok to be high for a bit in the morning. Just bolus and breakfast as soon as you can. Stay safe at night as priority. Hugs and stress can kill faster than high sugar!!!
I don't eat breakfast just coffee with cream. I reckon 6 is OK fro bed
 

SueJB

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Just to add to juicyj excellent post above, don't just change your basal dose based on 1 nights results, and wait at least 3 days/nights after adjusting basal to make another change.

Sorry Sue couldn't remember how long you've been diagnosed, it is possible to have some good numbers without taking bolus insulin while you're still in the honeymoon period.
I've been T1D for 7months. I don't eat enough carbs (20-30 per day) to bolus but I've noticed that my FBG is starting to rise eg, 6, 5.8, 7.8, 7.6. It does slowly drop during the day usually to around 5.5 at supper time. Not sure what to do really, perhaps I'll give it another day and then increase basal by 1
 

slip

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Hi Sue, those numbers are not particularly bad, just remember always give a good 3 days when making basal changes before coming to any conclusion.
 

therower

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Hi @SueJB . A few different things could be occurring. Honeymoon period starting to end. Another little trick diabetes plays on us is feet on the floor syndrome. Not everyone experiences it but it goes a bit like this. You get out of bed, take no carbs on board and have no bolus. Problem then is your liver decides " hey , here we go, I can't see any fuel so I'll save the day and provide some. "
This happens to me every Saturday morning. I get up but eat 2 hrs later. I need to inject a small amount of bolus to cover what my liver decides to do.
The only other option is to get up and have a breakfast with a few carbs , 1 toast and a bolus should be enough to stop your liver going into panic mode and trying to save the day.
Agree with @slip numbers are good and never react to quickly, give it time for a pattern to show.
 

SueJB

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Hi @SueJB . A few different things could be occurring. Honeymoon period starting to end. Another little trick diabetes plays on us is feet on the floor syndrome. Not everyone experiences it but it goes a bit like this. You get out of bed, take no carbs on board and have no bolus. Problem then is your liver decides " hey , here we go, I can't see any fuel so I'll save the day and provide some. "
This happens to me every Saturday morning. I get up but eat 2 hrs later. I need to inject a small amount of bolus to cover what my liver decides to do.
The only other option is to get up and have a breakfast with a few carbs , 1 toast and a bolus should be enough to stop your liver going into panic mode and trying to save the day.
Agree with @slip numbers are good and never react to quickly, give it time for a pattern to show.
I approve of your way of describing the dawn dump. It seems that not only do I have a wilful BG, I also have a wayward liver!
I don't eat breakfast and even if I did, 1 slice of wholemeal toast only has 9 carbs so I wouldn't bother having a bolus with that.
I get out of bed and immediately test, no loo, nothing so the liver must have panicked even before I got out of bed, I don't think it was dumping
 

therower

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@SueJB . Ah I see , I mistook the readings you quoted as a one morning rise. Apologies.