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Basal/Bolus ??

J

jayseven

Member
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15
Hi guys :) just want to start by saying "Great Site", my source for all info on diabetes.
Posted before but im still confused :(
I was diagnosed T1 at the start of the year, i am almost 29 female.
Doctors originally thought i had gestational D as i was first diagnosed when 11 weeks pregnant.
I went onto metformin straight away, unfortunatley I lost my baby boy at 20 weeks, Nov 2010, a scan showed he had anencephaly, which i think is a direct result of my diabetes so i had to deliver him early :(
From that time onwards Drs assumed the diabetes would go away, but it didnt, they diagnosed me with type 2 and i continued with the metformin and diet control, my levels continued to get very high and HBAC1 test showed that i was Type 1, and porobably was before getting pregnant.
anyway, type 1 since Feb 2011 and have only see diabetic nurse/doctor on day of diagnosis.
they never spoke about basal/bolus? i still dont quite understand how to take insulin according to carbs etc !!
I take Apidra @ 6 at breakfast, 5 at lunch and 6 at tea time.. is this a popular insulin??
I also take Lantus @ 14 (changed to 18 today after i rang diabetes nurse) at 1pm every day.
My levels drop quite low a couple of hours after lunch time as well, have hypoed a few times in work, so nurse told me to reduce my apidra from 7 to 5 at lunch - i just rang them cos i knew it wasnt right.. and they told me what to do, wish i knew myself what to do lol
** Should I take my apidra before or after eating meals?? i take it about 20mins after eating?
sorry for all the questions, but i feel so lost !!
My levels are quite high in the morning, last week = 12.4, 12.6, 11.4, 9.9, 10.8, 12.8, 14.3, 14.1

thanks for reading, and i cant wait to see your replies, im sure i will have more questions because i really want to get things as good as possible, i would like to try for another baby, but not until I understand disbates and how to control it.

hospital app on 7th sept so hopefully you guys can help me and i can go to the hospital in a better frame of mind :)
 
Hi jayseven,

I'm sorry to hear of your loss.

You really need to talk to the team and make sure they explain things properly to you. I'll outline some of the basics though.

Basal insulin (Lantus) or long lasting is to deal with the steady trickle of glucose that your liver releases during the day. Your fast acting (Apidra) insulin is to deal with what you eat. These are very common insulins to take.

Ideally you should count the grams of carbohydrate in your food and take a dose of Apidra to match that amount, using a ratio. Most people start off with 1:10, that is for every 10 grams of carbohydrate you take 1 unit of insulin. If you are having a sandwich that's 40g carb, you'd take 4 units. If it was 38g carb, I'd still take 4 units. You need to add up everything that you eat, though.

Test before you eat and two hours afterwards. Test again if you feel you are heading low. Now your ratios may change during the day. I need more insulin with breakfast that I would do for exactly the same thing at lunch. There are a number of books and apps that can help - I use the iPhone carbs and cals app and that has pictures so you can try to match a plate of food with the right carb content.

The easiest way though is to a) measure things yourself and b) try to reduce your carb intake. Broadly fewer carbs equals less insulin. I often take a salad of leaves, some onion, some peppers etc. and ham / chicken / fish to work for lunch. If you don't eat any carbohydrate, you shouldn't need any Apidra or only very little. Some people need to take some Apidra to cover protein, and some don't. It is all a bit trial and error though.

I'd recommend trying to get some time with a diabetic specialist nurse at the clinic and really if you can get on a DAFNE course (dose adjustment for normal eating) this will teach you how to carb count. Frankly the level of support you have had sounds terrible.

Anyway, here is the general advice for newly diagnosed members.

http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=20&t=17088

Good luck and please post any other questions you have. There are a few members either pregnant or TTC so you should be able to ask specifics on that as well.
 
Hi Russ

Thanks very much for your reply :) you have cleared some things up for me aready. I always take 6 units of apidra after lunch no matter what i eat ! sometimes i dont eat carbs at lunch ! so that is why i hypo a couple of hours after lunch !
so am i right in saying, every 10 grams of carbs i take 1 unit of apidra? i just bought book from amazon "Carbs and cals" it scared me when i first tried to read it lol
will defo be taking it with me in my bag from now on !

nothing like this has been mentioned to me at all ! i thought i had to take the same amount of insulin every day at every meal !
if i snack can i take insulin??
 
Hi jayseven,

Yes I guess that eating no carb and taking six units of Apidra is probably why you're going hypo after lunch!

The 1 to 10 rule is a good place to start. You might find that you need more or less, but it should be easier to adjust once you've started to get the hang of it.

Snacking is slightly tricky. The standard advice is that your long lasting insulin can cope with about a 15g carb snack in between meals (that's a small apple, for example). Any more and you would need insulin. Early on, you'll probably be advised to avoid doing that so that you don't 'stack' the insulin, i.e. have several doses working at the same time. You can snack on low carb things like meat, fish, cheese etc. Once you're more used to it, you can build more carby snacks in.
 
Hi Russ,

Thanks again for your reply :) really appreciate it.
I will take on board everything you have said, have been on the site for the last few hours reading various posts, so i feel alot more informed than i was earlier today..
i feel more confident about adjusting my apidra now, and will defo start to take more control with carb eating and counting and snacking ! dont think im too bad, but could be better.
Will post some levels and stuff over the next few days :)
Thanks

Jay
 
Hi Hyena

Had a look at the link you posted, its great ! thanks very much :)
all a learning process i guess ! hopefully i can take control of my diabetes now x

Jay
 
jayseven, reading your post I was furious (with your healthcare team) and hugely impressed (by you and your positive attitude in the face of everything). Good luck and don't hesitate to come back and ask any questions as they come up.
 
Hi Snodger :)
Thanks for reading my post - have read a few of your posts on various subjects over the last few days.
All very helpful, really appreciate it, i cant say enough how great this site is and all its members.
To me i have an invisible disease lol no-one really understands what we go through unless they have experienced diabetes first hand, DSN and doctors dont know as much as you guys lol

Thanks

Jay x
 
I originally hoped i had gestational diabetes as i found out i was pregnant two weeks after diagnosis. However, i suffered a miscarraige at 12wks that i later found out was a result of the diabetes so i can empathise with you and im also very sorry for your loss. I hope you manage to get your diabetes well controlled as soon as possible and you can start the family you want. If you have any questions about anything diabetic related feel free to ask and ill answer the best i can. :)

ps. i know exactly what you mean, know one does understand unless they also have diabetes, i have only just joined this site and already it feels like a huge help....i would never wish diabetes on anyone but its a relief knowing that other people feel the same way i do
 
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