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A question no one answers me!

Discussion in 'Insulin' started by PaulAuster, Oct 21, 2013.

  1. PaulAuster

    PaulAuster · Member

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    I'm a type 1 and I don't understand this question:
    Does the amount of fast acting insulin (Novorapid, Humalog) you take has anything to do with the amount of slow acting insulin (Lantus, Levemir) you take?
    I'll try to explain myself:
    Suppose that a person takes 18 units of slow acting a day, and takes also 10 units of fast acting at breakfast, 5 at lunch and 8 at supper. If one day he eats more at breakfast and takes 12 units of rapid, should we expect that slow insulin doesn't work so well during the rest of the day, having to increase the amount of slow acting? Or on the contrary, does slow insulin just depend on body weight and abdominal fat of the patient?
    I've read some articles that say that basal insulin should not ever have any hypoglycemic effect, maintaining stable glucose even if we skip a meal. In fact, they say that the way to test if your basal insulin rate is correct is skipping a meal and checking if glucose remains stable. Is that true?

    Thank you!
     
  2. mo1905

    mo1905 Type 1 · BANNED

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    The way I understand it is the first priority is to get your basal levels right. Then, the bolus should just be a ratio to carb intake. Your basal should be at a level that if you don't eat, should remain fairly stable throughout the day. If you don't eat and your levels continually drop, your basal is too high, and vice versa.


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  3. mrman

    mrman Type 1 · Well-Known Member

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    Only way that your basal would need increasing/decreasing on a day to day basis is of its wrong. If your not having enough you might be unknowingly covering it with the qa. If your having too much basal you won't need as much qa. as mo said important to get your basal right, then work on your qa ratios.

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  4. noblehead

    noblehead Type 1 · Guru
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    Basal insulin is just a background insulin that deals with secretion of glucose from our livers, if the dose is set too high then you'll more than likely hypo, too little and your bg will climb. They say when you get the basal dose right your 50% there, without doing so your chasing your tail.
     
  5. phoenix

    phoenix Type 1 · Expert

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    Agree with the others but that's not to say that correctly set basal insulin will never have a hypoglycemic effect.
    A basal that keeps your levels stable whilst sitting may be too high during exercise .
    Also some peoples basal needs vary tremendously during the day. People on pumps may change their basal rate from hour to hour. You can't do that using a basal insulin . Some people may find it really difficult to get the correct dose and timing of injection(s) to keep their levels stable throughout the day.
     
  6. Geri

    Geri Type 1 · Well-Known Member

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    Agree with the above comments, however, I have been told that if you count carbs, then a guideline is to have twice the amount of slow acting insulin (basal) to quick acting insulin (bolus), For example,if you take 11 units of quick acting insulin throughout the day for your breakfast, lunch and tea -(4 units for breakfast + 3 units for lunch + another 4 units for dinner), then a guideline would be to take twice that amount for your background insulin. However, this equation doesn't work for me!!!! as I only take one unit in total more for my background insulin.

    This was given as an example on the Jigsaw program (similar to Dafne) I took a while ago. The others on the course could verify this equation except for myself. So it is really a case of careful monitoring in accordance to what you have been taught by your healthcare professionals and your daily activity and amount of carbs eaten.
     
  7. mrman

    mrman Type 1 · Well-Known Member

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    Not sure but I think the general rule would be to have the SAME amount of basal as your total bolus, I.e if you have 11 units qa in total a day on average, a starting point would be 11 base, resulting in 50% basal,50% bolus. This is usually not correct for many people. Only way to find out is through basal testing.

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  8. ElyDave

    ElyDave Type 1 · Well-Known Member

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    So far I've found that my basal is quite a bit higher than my bolus in total.

    Typical bolus insulin for me is maybe 6-8 units a day, 10 if i have a pudding as well. Basal, which I'm pretty happy with is 14 units per day, so twice typical bolus.

    My basal does need to be dropped quite a bit before extended exercise, plus ingesting carbs as I go, so drop breakfast from 6 to 3 units, bolus of just one units, then 45-60g carbs per hour and the next bolus dose cut by half.

    I am typically very insulin sensitive with a 20g carbs/unit ratio, and also quite lean at 67kg and 1.75m
     
  9. amandeep

    amandeep · Newbie

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    My brother has type 1, he takes lantus at about lunch time and when we have to test how much of lantus is enough, we test in the early morning at about 4am and again before having breakfast. if its the same that means the lantus is enough and if its increasing then we increase the lantus dose until the sugar level at both 4am and 8am is the same or similar. Humalog is then injected with each meal according to what is being eaten.
    When he started taking lantus, he took it at night but he had hypos during the night and the sugar level was high in the evenings so we shifted it to lunch time. I think the lantus works for a bit less than 24 hours so the sugar level used to go up just before injecting again. when we inject at lunch time, the level doesn't go up as Humalog works for about 4 hours so it is still in action.
    The hours between his lunch and dinner is more than then his breakfast and lunch so that has suited him.
     
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