Calculating basal insulin

[SueJB]

Another of my questions!!!
Can anyone tell me how to check if my basal insulin dosage is correct or point me to a simple web site?
I sort of get the feeling that when I was first diagnosed (Aug 2017) they just guessed, they weren't even sure at the start if I was type 1 or 2. They've decided I'm type 1.
The second time I went to see the DSN, I asked about insulin to carb ratio (bolus) only to be told I didn't need to worry about it. I read and am intelligent and I don't like being fobbed off so any help on this would be useful. Thanks

 

[db89]

Hi SueJB - I have used the MySugr article on this to do basal testing. Ignore the part about pumps as the info is also applicable to MDI. You'll probably also need the blood sugar converter from this website to swap the mg/dl to the mmol/l we use in the UK.

 

[Marion1102]

Try to get on a DAFNE course as they explain, and also check your basal, on the course

 

[slip]

Sue - I guess you're currently on fixed dosages from basal and bolus at the mo and told to eat a certain amount of carbs per meal?

Dafne courses are run about once a month in Oxfordshire, I have contact details and some dates easy at hand so PM me if you want that info. (http://www.dafne.uk.com/)

 

[SueJB]

Sue - I guess you're currently on fixed dosages from basal and bolus at the mo and told to eat a certain amount of carbs per meal?

Dafne courses are run about once a month in Oxfordshire, I have contact details and some dates easy at hand so PM me if you want that info. (http://www.dafne.uk.com/)

Brilliant thanks. Correct on the fixed doses but I feel they're wrong, not sure if they're too low or too high. I thought the only way to get onto a DAFNE course was through a DSN

 

[slip]

So long as you've been told how to correct a low, and possibly your correction dose if too high, they are playing safe for the time being. keep testing and logging results and food intake, they'll get you on a proper basal/bolus dose adjustment regime.

Might be worth running it past your DSN, and if you can demonstrate you've got a good handle and understanding theres no reason why they should get you on a dafne course - well in fact NICE guidelines suggest that is what you should be on anyway.

 

[mountaintom]

Another of my questions!!!
Can anyone tell me how to check if my basal insulin dosage is correct or point me to a simple web site?
I sort of get the feeling that when I was first diagnosed (Aug 2017) they just guessed, they weren't even sure at the start if I was type 1 or 2. They've decided I'm type 1.
The second time I went to see the DSN, I asked about insulin to carb ratio (bolus) only to be told I didn't need to worry about it. I read and am intelligent and I don't like being fobbed off so any help on this would be useful. Thanks

Are you still on the same doses they sent you home with?
I’m a month since T1 diagnosis and have adjusted my doses myself as they were too high and I was having hypos all over the shop.

 

[SueJB]

So long as you've been told how to correct a low, and possibly your correction dose if too high, they are playing safe for the time being. keep testing and logging results and food intake, they'll get you on a proper basal/bolus dose adjustment regime.

Might be worth running it past your DSN, and if you can demonstrate you've got a good handle and understanding theres no reason why they should get you on a dafne course - well in fact NICE guidelines suggest that is what you should be on anyway.

I've been told how to do correction for a hypo. From what I've read on various forums, my insulin dosage is tiny compared to most people. Levemir 3 units twice daily/ preprandial 1-2units Novorapid and use this as correction if needed.
I was originally on 4 Levemir when first diagnosed, then a couple of days later 5 units and then watched my weight increase!!! So I assumed the dose was too high, reduced it to 4 and then gradually to 3 and have kept BG with range of 4-7 with only the odd blip. I talked to the DSN about it but she said to carry on with 5 but I just feel I know my own body better. We'll see, perhaps it'll be no fool like an old fool or you can't teach an old dog new tricks.

 

[SueJB]

Are you still on the same doses they sent you home with?
I’m a month since T1 diagnosis and have adjusted my doses myself as they were too high and I was having hypos all over the shop.

Hi, welcome onboard. I've adjusted my basal dose myself not because of having hypos which are very rare for me but because the basal didn't seem right. Hope you're coping

 

[rmz80]

My understanding (from a published hospital crib sheet) of correct dose base is to reach a wake up reading of 5mmol/L or above, if less (4.5-4.9 two days in a row or one day below 4.5) then deduct 1 unit from base and retest the next morning. This also knocks out the add on fast carb count ratios but can’t be helped; its start again each time the base is touched. I ended up doing this 26 times in 8 months when losing weight.

 

[SueJB]

My understanding (from a published hospital crib sheet) of correct dose base is to reach a wake up reading of 5mmol/L or above, if less (4.5-4.9 two days in a row or one day below 4.5) then deduct 1 unit from base and retest the next morning. This also knocks out the add on fast carb count ratios but can’t be helped; its start again each time the base is touched. I ended up doing this 26 times in 8 months when losing weight.

Thanks, that's really useful

 

[SueJB]

Thanks, that's really useful

An after thought, I split my basal, do you think the deduction should come from the morning or the evening dose?

 

[Scott-C]

Don't know what basal insulin you're on, but it's often worthwhile having a look at the manufacturer's instructions.

Lantus, for example, has a dosing calculator which works out at about weight in kilos divided by 5, or a lbs version at link below, but they make it clear that it's just a starting point for new users and will need tweaking for individuals.

www.lantus.com/hcp/dosing-injection/insulin-dose-and-dosing-calculator

 

[Bertyboy]

Another of my questions!!!
Can anyone tell me how to check if my basal insulin dosage is correct or point me to a simple web site?
I sort of get the feeling that when I was first diagnosed (Aug 2017) they just guessed, they weren't even sure at the start if I was type 1 or 2. They've decided I'm type 1.
The second time I went to see the DSN, I asked about insulin to carb ratio (bolus) only to be told I didn't need to worry about it. I read and am intelligent and I don't like being fobbed off so any help on this would be useful. Thanks

Your situation sounds very similar to mine. I thought (from reading these forums) that fixed doses were an initial, simplistic guide to get you used to injecting. I was told (in November, on presentation) 12+12 units of Levemir and 6 units Novorapid per bolus.
The DSN told me on several visits to maintain this. My first dieticians appointment was met with "I think you should try metformin instead", and I asked if I could do this with my initial consultant appointment shortly after; she said no, carry on as I am because my HbA1C and FBG results were all excellent. I had adjusted my basal units anyway (initially up to 14, as the FBG levels initially plateaued at about 11, and then recently back down to 10 as I find that does the trick now), and said that I don't feel comfortable not knowing how I react to either carbs or insulin. So, she did agree to refer me back to the dietician (at some point) to go over adjusting doses, but also said to just keep experimenting myself if I want to see what happens with lower and lower basal. So, I'm currently trying 8+8 units.

 

[SueJB]

Don't know what basal insulin you're on, but it's often worthwhile having a look at the manufacturer's instructions.

Lantus, for example, has a dosing calculator which works out at about weight in kilos divided by 5, or a lbs version at link below, but they make it clear that it's just a starting point for new users and will need tweaking for individuals.

www.lantus.com/hcp/dosing-injection/insulin-dose-and-dosing-calculator

Hi, I'm on Levemir but that's a good idea of yours to check the manfacturer's info, thanks

 

[SueJB]

Your situation sounds very similar to mine. I thought (from reading these forums) that fixed doses were an initial, simplistic guide to get you used to injecting. I was told (in November, on presentation) 12+12 units of Levemir and 6 units Novorapid per bolus.
The DSN told me on several visits to maintain this. My first dieticians appointment was met with "I think you should try metformin instead", and I asked if I could do this with my initial consultant appointment shortly after; she said no, carry on as I am because my HbA1C and FBG results were all excellent. I had adjusted my basal units anyway (initially up to 14, as the FBG levels initially plateaued at about 11, and then recently back down to 10 as I find that does the trick now), and said that I don't feel comfortable not knowing how I react to either carbs or insulin. So, she did agree to refer me back to the dietician (at some point) to go over adjusting doses, but also said to just keep experimenting myself if I want to see what happens with lower and lower basal. So, I'm currently trying 8+8 units.

So long as you've been told how to correct a low, and possibly your correction dose if too high, they are playing safe for the time being. keep testing and logging results and food intake, they'll get you on a proper basal/bolus dose adjustment regime.

Might be worth running it past your DSN, and if you can demonstrate you've got a good handle and understanding theres no reason why they should get you on a dafne course - well in fact NICE guidelines suggest that is what you should be on anyway.

Thansks. Doesn't it sound like they're guessing and asking you to guess too. Well at least that'show I feel. One DSN was less than useless. "We like you to take ownership" a sentiment I totally agree with IF you have a decent knowledge base to start from. So from what you've said, you're keeping morning and evening basal dosage the same right?. Diabetics are supposed to be offered a DAFNE course withing one year of diagnosis. I'm 6 months new

 

[SueJB]

Are you still on the same doses they sent you home with?
I’m a month since T1 diagnosis and have adjusted my doses myself as they were too high and I was having hypos all over the shop.

Hi, No I've been fiddling around with the doses and I seem to be doing alright.... but I don't like this guess work. I am not tolerant of ambiguity and it really ppppps me off this lack of precision and the fact that I wasn't told fiddling was OK. Hope you're doing well.