Basal / Bolus tips etc.

[ClaireG 06]

I'm a type 2 and on mixed insulin at the moment. I have been having quite a few problems health wise, not all diabetes related.

Anyway, last night i saw a different DN to my usual one. She gave me a good MOT and said she didn't really like mixed insulin and agreed with me that it isn't very flexible or easy to tweek.

I am going back to see her on the 4th Oct and she is starting me on basal/bolus. She's booked a double appointment. Until then i am keeping a BG and food diary so she can see what my levels are doing to give some pointers of how much of each of the insulins i will probably need and when and which would be the best for me to try.

Apart from asking about DAFNE and carb counting, can anyone think of anything else i should ask or have you any tips for me?

 

[Fallenstar]

Hi Claire

Sorry to hear of your other health problems and I really hope they settle soon ,it can't be easy for you at the moment.
Can I ask Claire what your HbA1c is at the moment? Are you struggling to get good control?

If not, then If I had my time again I would seriously think about whether I would want to swap 2 injections a day with good control, to go onto 6/7 injections a day. Which may in some way give you more flexibility in what and when you eat but if you are already doing well on the Mixtards I would think seriously before changing.
Obviously if you are struggling on the Mixtards, then go for it. It really will just be about trial and error and lot's of finger pricks at first.
I liked the Mixtards, maybe I view them through rose tinted glasses, I don't know. When my Diabetes was not as far down the line and control was easier.
Obviously if the Basal/Bolus regime will help you with your other health issues then it is a must..but if you are good to go as you are and just looking for some more flexibility...well in my opinion based on my experience the Basal/Bolus was not the Diabetic Panacea it was touted as ....Maybe the pumps the answer for us, but I think you have to be prepared to sell your soul to the Devil for one of them :wink: :lol:
Good luck Doll, whatever you decide

 

[ClaireG 06]

Thanks

My last HbA1C was 8.5. I was fine on the mixed insulin (Humulin M3) to start with but in the last month or so my BG's have been shooting up again and i'm really struggling.

Having high blood pressure and possible cardiac problems puts me at increased risk to, so i really need to get those numbers down.

 

[iHs]

Hello Claire

I feel the same way about bolus/basal as Fallenstar. Unless you have a good dsn who will explain to you how you go about changing your insulin to carb ratios at different times of the day according to what your bg levels are and the amount of carb that you are going to eat, basal/bolus is difficult for people to get good control with.

Initially basal/bolus is usually calculated on a persons body weight and whatever that dose is, 50% is usually on basal and the other 50% is bolus divided up over 3 injections.

It will be by you testing your bg levels every 2.5hrs after your morning breakfast dose that you will be able to know whether the ratio you are using is correct. Insulin to carb ratios are better than just using guesswork although everything is trial and error in the beginning anyway.

Most people start bolus/basal using the ratio of 1u bolus to every 10g carb that is eaten (1:10) and then by testing frequently, they then realise whether they need to alter that ratio. I found it easier to alter carb in the ratio than alter insulin. So instead of using a ratio of 1.2:10 I used 1:8.

You will get the hang of how it works but will take you a while to figure it all out.

BDEC carb counting on line is fairly good as it explains about correction doses and how to calculate them.

Have no idea what insulins you will be started oget but yourself onto an insulin pen that delivers in 0.5u increments as that will help you acheive better bg levels than just using a 1u pen.

There are loads and loads of threads on the forum all about carb counting and ratios.

Good luck

 

[Fallenstar]

Hey Claire
Brilliant advice from iHs, and I can't agree more with the testing 2 to 3 hours after eating . I find this the most important of the blood tests to find out trends and make tweeks/adjustments.
We are told to test alternate days, one day before breakfast and then evening meal.The next day before lunch and bed time, then to alternate them... :roll: I know they want to save test strips but no way is this enough to get a good idea of your continuous BG, I test after every meal (and before) and this gives a much better overall picture. You will need to do the same on Basal/Bolus.

I think correction doses are much more encouraged now than a number of years ago, and to do these we need to be doing BG tests after meals. I met one lady recently on the DAFNE who had had Type 1 45 years and had never done a correction dose and never did a between meal BG check :shock: So this Basal/Bolus was then not that flexible was it??

Well your HbA1c is not bad really, but like mine (8.1)it could be better, I was looking through my medical records the other day, never bothered before and I looked at all my HbA1c's over the last 20 years and I have never been below 8 ever since first being put on insulin. I have always had a HbA1c around 8 the whole way through, on either Mixtards or Bolus/Basal. So did it improve my control ,no. Has it been more hassle ,yes to be honest.
And, I never did have night time hypo's on Mixtard but that could be my Diabetes now and I have to consider that possibly Mixtard would be useless for me now as my disease has progressed.

All I'm saying Claire is do not think it will be the answer to better control because that might not be the case, then again it may be for you. Interestingly looking back through my HbA1c's the only time I had PERFECT control, HbA1C's of 5 was when I was pregnant and sat on the sofa nursing my Diabetes 24 hrs a day for the sake of my babies...and that is no life for anyone believe me.

You may find with being Type 2 if you are insulin resistant that it works like a dream for you. Some Type 1's that I have met including myself that are on the sensitive side to insulin and have no resistance at all do tend to struggle more .So give it a go ,it may be the answer to help you get better control which will be one less thing for you to worry about at the moment Hun, which I'm sure you could do with right now with everything else that is going on with you health wise at the moment.

I wish you all the best Claire

 

[ClaireG 06]

Thanks both

Although my other dn suggested i only need to test twice a day on the mixed insulin, directly before i use it, i test a lot more! I always test fasting, before meals, two hours after meals and bedtime as well as anytime i go near the car.

I am prepared for it to be harder and perhaps not give me better control but think i will give it a shot. Will defiantly look at BDEC and ask about DAFNE.

 

[traceysappho]

i am type 2 on huge amounts of insulin 150 units of novorapid 3 times a day 250 units of levemir at night and 30 in the morning. my bloods have been in the 20s for five years and all the clinic keep saying is increase the insulin. I have just figured out that its the carbs i am eating, no-one told me any different. \in three days my bloods are down to 17 and 20 in the morning. big improvement. But when do i start to decrese the insulin?