Basal night dose very low - is this normal!

[char87]

Hi

I just wanted to check something. I know on lower carb diets basal needs will reduce, but I have now dropped to only doing 5 units a night and still woke up low this morning (went to sleep 6 and woke up 3.9) I sually eat around 100g of carbs a day and do ahlf an hour exercise (usually running) so my carb amount aren't extremely low carb.

I am a normal weight and have been diabetic for 20 years. Just finding it very odd how much my basal requirement is dropping- I was on 10 units at the start of the year and on 14 before i started low carbing. Has anyone else had this - am so used to injecting insulin I find it a bit worrying now when I don't seem to need much!!

Thanks
Charlotte

 

[noblehead]

Just reduce your basal insulin again until your morning levels stay in your bg range as it doesn't matter what dose you take, but do be sure that the dose is enough to keep your bg levels stable throughout the day as well, basal testing will determine if this is the case.

 

[Spiker]

Low carb diets don't reduce basal needs. It's just that many people on higher carb diets will have their basal rate set too high. So part of their basal dose is being used to mop up part of their carb dose.

This is why it's a good idea to do a fasting basal test for 12-24 hours before starting a low carb diet

 

[LucySW]

Ask @Heathenlass, who uses a tiny night-time basal dose.

 

[char87]

Thanks for the replies- I know about basal testing and have been doing this. I just find that I do it and a doseage works for a short while and then I start hypoing again and need to readjust and drop it even more. I had another hypo on 5 units last night so am probably going to need to drop it again which just seems very odd as in 20 years I have never needed this low a dose- am barely needing any insulin at the moment and am not very low carb. Just wanted to see if others had experienced this and looking for reassurance reslly that there isnt something weird going on!

 

[tim2000s]

I wouldn't call it weird. I'd say it was great When I went low carb, high exercise, my basal dropped from splitting 20u:20u morning and evening to being 8u/6u evening, dependent on gym days and 14u during the day. My typical total bolus amount during the day is around 12-15u split out due to the way my body converts protein. I'm certainly using MDI, but not in the classic 2 basal/3 bolus model. Far more "sugar surfing".

But it works for me, and doesn't get in my way, and that's by far the most important thing.

 

[Daibell]

Low carb diets don't reduce basal needs. It's just that many people on higher carb diets will have their basal rate set too high. So part of their basal dose is being used to mop up part of their carb dose.

This is why it's a good idea to do a fasting basal test for 12-24 hours before starting a low carb diet

I agree about the low-carb aspect but isn't it possible that if you lose weight thru low-carbing that insulin resistance will drop. For those overweight with?insulin resistance I assume some of the Basal is there to add to the body's own insulin excess so that the body may at least use some of it. We've seen posts from many with high weight who have to inject enormous amounts of both insulins to counter insulin resistance.

 

[noblehead]

Just wanted to see if others had experienced this and looking for reassurance reslly that there isnt something weird going on!

Don't think there's anything weird going on, around 7 years ago I was injecting between 32-36 units of lantus and before changing to a pump I was injecting 17 units, I put this down to a few things, losing weight, being fitter than before and eating a reduced carb diet, like you I don't low-carb (as in below 50g a day) but do eat them in moderation.

 

[char87]

Thanks very much for all your comments- will just go with the flow and keep testing then! Hoepfully it will settle down again soon - am getting a bit tired of jelly babies with all these hypos!

Thanks
Charlotte

 

[Spiker]

I agree about the low-carb aspect but isn't it possible that if you lose weight thru low-carbing that insulin resistance will drop. For those overweight with insulin resistance I assume some of the Basal is there to add to the body's own insulin excess so that the body may at least use some of it. We've seen posts from many with high weight who have to inject enormous amounts of both insulins to counter insulin resistance.

No that is a very valid point. Your basal requirement will reduce in proportion to your weight loss, even if insulin sensitivity doesn't change at all.

And if the low carbing reduces liver fat (more likely in T2s) then that will reduce insulin resistance / increase insulin sensitivity.

 

[paulskitty]

I've started low carbing a few days ago and dropped my background to 6 (which is proving too much as I'm dropping 3mmol at night!) previously was on 22units of background. X

 

[Spiker]

Ok it may help to think about what a correct basal level really is. A correct basal level (in basal bolus regimes) is the amount of insulin needed to suppress glycogen release and / or mop up any glycogen, gluconeogenesis, or any ketone products. It should not be used to mop up all or part of the carbs (including gluconeogenesis carbs from protein) in a typical day's bonuses. The whole point of basal bolus is to permit flexible bolus. Otherwise we could have stayed with fixed meals and fixed times and fixed doses of long acting insulins. If we are doing basal bolus we have to separate the basal from the bolus. To the extent we combine the two, we confuse the two, and we lose the flexibility that basal bolus offers - and create avoidable highs and lows every time we deviate from a "typical" meal. Not good.

I suspect that most T1s on a normal (none low carb) diet have their basal too high and their insulin ratios too low.

While I accept as a fact that low carbers reintroducing carbs will transitionally see large unexpected BG spikes, I don't agree that it makes any sense to label this "insulin resistance". In fact "insulin resistance" has long been a label for a bunch of different phenomena, with the only unifying fact being we don't understand how any of them actually work at a biochemical level. Prof Taylor's work as far as I know is the first ever to demonstrate an actual mechanism.

 

[Charles Robin]

Basal needs vary massively by weight. I am currently on 15.5 units of Lantus (which may actually be too much but I'm about to be changed to Tresiba and that's another story). However, I'm 11 stone 7 and 5'11". I know a lady who is short and weighs next to nothing. Her basal dose is about five units of Levemir. The saying 'eat to your meter' can also apply to your insulin requirements. Even if a dose seems small, if you are getting good results then it is right for you.

 

[Heathenlass]

Ask @Heathenlass, who uses a tiny night-time basal dose.

Thanks for the tag, @LucySW , sorry I missed it !

I use 1.5 or 2 units as a night time basal dose of Levemir, and that keeps me steady. Though trial and experience the half unit raise is needed at " hormonal times " The morning dose is 10 units .

Total daily dose of basal and bolus is 22 units , the bolus doses calculated in half units .

During my "NHS dietry advice experiment " years, my doses sky rocketed , I can't remember the exact figures and would need to dig out records for that time, but roughly four to five times what I dose with now . I also gained weight for the first time in my life, and had the highest HbA1c results I have ever experienced.

Believe me, lower doses are a good thing!

Signy

 

[smidge]

Mmm...I think I have to disagree that low-carbing doesn't reduce basal requirements - it most certainly does.

I agree with Spiker that a basal dose should just hold you steady, but that assumes that a basal insulin has a very flat profile. From my experience, Levemir certainly did not have a flat profile FOR ME. It was very peaky and unpredictable - can't comment on Lantus. In the end we can only work with the insulin available to us and it isn't perfect. Instead of expecting a flat basal profile, I found it better to use an NPH insulin which was at least predictable in its peakiness and allowed me to use the peak to cover part of a meal and reduce bolus ratio accordingly. Not perfect, but not wrong and the best I could do.

Throughout my time on Levemir and Insuman, I always had to split dose to avoid hypos and try to get the basal to last for a long enough duration (12 hours was the absolute longest it lasted for me) and I always had small doses (7 units Levemir of an evening or 5.5 units Insuman). However, if I ate more carbs my background level rose and I needed more basal to cover the higher background level.

Now I've changed to Tresiba, I'm hoping to use the basal just to maintain background at a steady level, but this is the first time since i've been diagnosed that I have a basal that has a chance of achieving that.

Anyway, whatever the reasons for the smaller doses, small doses are a good thing!

Smidge

 

[Spiker]

Actually I think there's an underlying assumption there - that our basal demand itself is "flat". Manufacturers try to make flat profile basal insulin because they assume basal demand is flat. And yet there is so much evidence that our basal demand is far from flat. For me the most obvious benefit of a pump over injections is that you can program the pump to fit any pattern of basal demand. When I was using pens I was actively looking for insulin that was *not* flat - I was looking for insulin with peaks that I could combine to match the natural peaks and troughs of my basal demand.

 

[noblehead]

Actually I think there's an underlying assumption there - that our basal demand itself is "flat". Manufacturers try to make flat profile basal insulin because they assume basal demand is flat. And yet there is so much evidence that our basal demand is far from flat. For me the most obvious benefit of a pump over injections is that you can program the pump to fit any pattern of basal demand. When I was using pens I was actively looking for insulin that was *not* flat - I was looking for insulin with peaks that I could combine to match the natural peaks and troughs of my basal demand.

Yes totally agree there Spiker, the beauty of a pump is the ability to adjust your basal rates throughout a 24 hour period, extremely difficult.......if not impossible to replicate on injection therapy.

 

[mrman]

Also, warmer days/nights starting, which I find has a big effect on my basal doses. Currently working down from my winter rates (11 Units) to my summer rates. Not quite here yet though so reduced in between at the moment, but sure I will end up back on on 6-7 units basal within the next few months. Am pumping now, but, even on mdi had to seasonally adjust.

 

[donnellysdogs]

Snap.. Two weeks time with change in times I will be lowering every basal...

 

[tim2000s]

Can't say I noticed a difference between summer and winter basal requirements. I do notice a difference between cooler and warmer climes though, warmer needing less insulin.
I'd agree that basal requirements are not necessarily flat, given my differing night time and daytime basal levels. What I note is that during the day I etc more carbs and protein whereas overnight I don't eat anything.

In theory I should use the same amount, but even on fasting tests, I need the higher dose during the day to maintain a flat bg level. I'm guessing other things are coming in to play...