Basal bolus

dookie said:

Hi all.

Have been put on this regime using Levemir and Novarapid. Anybody else on this and can offer any advice or comments.

Thanks

Andy

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Hi @dookie

That was precisely what I was on (back in the days where I needed insulin). For me it gave few problems and once coupled with a low carb lifestyle, and I was able to reduce the dosages under supervision until I reached the point where I didn't need it at all.
The key was the reduction in carbs which lessened the yo-yo effect of hyper and hypo. However for reducing my hba1c from 101 at diagnosis to just 51 in a few months, it was very effective

Tagging @Mep and @ickihun for you @dookie as they're Type 2s like yourself

Can you tell us a little more about your doses, whether you count carbs, your HbA1C, etc?

I'm Type 1 so my situation is slightly different to yours, but I found a basal/Bolus regime to be excellent, allowing flexibility and good control.

I'm on lantus and now humalog ( switched from novolog) and also use a very low carb diet to keep insulin doses small to reduce the yo yo and hypos hyperspace too. I could never get insulin and food to get there at the same time and much easier FOR ME to be low carb higher fat.

Many do well with more carbs but I don't. Keeping insulin doses low and carbs very low with higher heathy fats keep me very steady

We are all very different. Are you on set doses? If so you need to discuss things with your team as far as whichever diet you choose to follow.

How are your meter readings? Staying steady and in your desired goals?

dookie said:

Thank you all for your replies. My Levemir will be 40 units and my novarapid will be split 10 breakfast 14 lunch and 16 dinner to start with. I am also going to take dapagliflozin. I hope to be able to lower my carb intake to help me lose weight.

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Then ask roughly how many carbs you should be eating for those meal doses as that should make your sugars smoother.

dookie said:

Thank you all for your replies. My Levemir will be 40 units and my novarapid will be split 10 breakfast 14 lunch and 16 dinner to start with. I am also going to take dapagliflozin. I hope to be able to lower my carb intake to help me lose weight.

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If you are on fixed doses of insulin then those fixed doses will be designed to deal with a certain amount of carbs, if you reduce your carbs without understanding how to adjust your insulin for carb intake you risk hypos.

Hi @dookie .

These units sound like starting units gauged by your dn to see which meal is more insulin resistant to you.
On those units your dn expects your dapagliflozin to do most of the hard work on a morning and peating off as the day prolongs.
I am surprised both routines are being started simultaneously but your dn may have excellent experience with both routines and to save fluctuating insulin routine they have added dapagliflozin immediately. Your hba1c must be very high?
You sound in good hands. Have you been told your dn will call you every few days whilst this new routine beds in? If not they still may call. Have you been given dn's telephone number too?
When are you expected to visit your dn next?
You need to always work with your medical team as we can only tell you our experiences but your dn has your full medical care in their hands. They know more than me, for sure.
In my experience of levemir and novarapid (5yrs ago) I too found smaller changes (e.g 2units at a time) caused smaller risk of hypoing.

This dapagliflozin tablet can cause thrush or water infections but many don't. Also this kind of med can cause dka difficult to detect at a&e. This tablet can show lower bg levels on our meters but still be suffering dka from circulating glucose. Please familiarise yourself with dka symptoms and carry this tablet info in your wallet for emergencies with your new insulin info cards.

When do you start this dual treatment?

Hi @dookie - My endo also has me on fixed dosages of insulin but to be honest I haven't been following his advice as I've learnt that I need to carb count in order to adjust my insulin correctly. On his fixed dosage I could wind up too high with BSL or too low depending what I ate. For some reason here they don't feel the need to educate type 2's properly on the use of insulin... they just tell you what to do. I'd rather know how much insulin I actually need. If I'm going to have a low carb meal at all (I do sometimes) then I need to drop my dose significantly. Whereas if I eat 30g of carb or so with my meal I need to bolus the correct dosage to avoid hypers or hypos. When you carb count you take the insulin you need for the carbs you are eating. For me I've worked out my insulin to carb ratio on average and it's higher than what they recommend because I'm insulin resistant so I need more insulin per 10g of carb. I did the free online course too which was very helpful.... you might find this helpful too. https://www.bertieonline.org.uk/admLogin.asp I wish you the best.