Drop Basal?

Sue think my question about bed time BG may have got lost in the thread, but if you could give us an indication of what your BG is like before going to bed as well just to complete the picture, thanks.

SueJB said:

Just wondering if anyone has been told to stop basal insulin and only bolus with food while still in "honeymoon"? Thanks

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Hey,

I too am in the honeymoon period, being diagnosed in Feb. My long acting insulin started at 13 then I’ve been slowly reducing it to keep BS from going too low. I seem to be reducing it each week, sometimes making a slight change daily and watching how I react.

I am currently on 5 lantus which I take at night and I usually wake up in high 5s or 6s. My fast acting ratio is always changing and sometimes I don’t inject for meals if low carb, but usually inject 1 or 2 units for each meal. It’s still a total guessing game when deciding how much to inject as the 1-10 ratio doesn’t always work out..

If I was you I’d speak to nurse but I’ve been adjusting myself really as we communicate via email and she sometimes doesn’t get back to me for a few days. I just do what feels right for me. I feel best in 5s, but safer around 6 -7 for BS so that’s all I’m aiming for atm. I keep a diary for what I’m eating and injecting and that helps me play around with numbers the next day.

Good luck!

I think the point has been made that you probably don't need to stop your basal.
If you decide to reduce it, I would suggest doing it very gradually as it my take a few days for the difference to take affect.

By the way, I am not sure what you mean about "excess" insulin. If you had too much insulin, you would be going hypo as I am not aware of any way of it not being active.

SueJB said:

Thanks @boboblck really glad you're doing OK. I like to wake up with a 5 and usually smile when I see that number but to be honest I'd prefer 4.

As I said before, I have no confidence in any of the diabetic nurses I've spoken to. I was originally put on 5 units twice daily basal but have reduced this of my own accord to 4 and 4 am/pm which seems to do the biz. I think I'm going to try 3/3 and see how that goes. I've kept a food diary since diagnosis and since I was never a big carb eater, apart from fruit, my diet hasn't changed much.

I suppose what concerns me, apart from keeping BG in range is putting on weight which I have done since diagnosis. I dropped 17k but that was in 2 years so wasn't that bothered. However, since T1D, I've blobbed on 8k and for a little person, I now weigh too much. Because I know that insulin is the fat making hormone,I don't want any excess sloshing around. I don't bolus unless I'm having a piggy which is really rare so the only way I can avoid the fat maker is further reduce basal. I've also increased exercise and got a free exercise bike, swim and have a normal bike too which I use regularly but still the weight creeps on!!

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The advice, care and treatment we all get does seem to vary a lot depending on location doesn’t it. I was originally on 5 fast acting three times a day and I adapted from there. I didn’t eat that much carbs before either, and still don’t now. I am struggling with the set dinner times as I used to just eat little bits here and there before. I’m definitely eating a lot more than I did before and it’s putting weight on me too.

Just had aaaanother hypo after dinner tonight. Think was the sweet potato .. too slow releasing? Had 40gram and only injected two units. Having hypos doesn’t help keep the weight off lol

As for insulin reduction for losing weight, this is what I gather.. reducing bolus should bring down the basal as basal is roughly double what you inject for the day.. It’s not that insulin makes you fat as non diabetics produce it and everyone isn’t over weight. It’s more what you putting in. Low carb makes sense to me, very small amounts of it at least with meals so less risk of messing things up and should help manage weight too.. loads of vegetables and healthy fats.. I don’t know what I’m talking about though at all but I think might work! Lol

You sound like you doing amazing with the exercise! I just go for a walk every night and bit of weights before bed just. Never was one for the gym but might have to start!

Lovely to have this app and hear from people in similar situations. I’m sure you’ll get some great advice from experienced type 1s. I know I need a lot! Good luck.

X

boboblck said:

.. reducing bolus should bring down the basal as basal is roughly double what you inject for the day..

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Not necessarily double, mine usually works out at 80-90% basal since going low carb. Was around 50:50 before that. Basal is what keeps you ticking over, so can easily be the lion’s share of your insulin

Mel dCP said:

Not necessarily double, mine usually works out at 80-90% basal since going low carb. Was around 50:50 before that. Basal is what keeps you ticking over, so can easily be the lion’s share of your insulin

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Aw thanks! My DN told me that when was last in so it’s good to hear from you- someone who’s reduced carbs and how it actually works.

boboblck said:

Aw thanks! My DN told me that when was last in so it’s good to hear from you- someone who’s reduced carbs and how it actually works.

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I imagine they’re basing that on someone who does as they’re told and eats all the carbs. Some days I take no bolus at all, most days less than 5u; with 17u basal.

Mel dCP said:

I imagine they’re basing that on someone who does as they’re told and eats all the carbs. Some days I take no bolus at all, most days less than 5u; with 17u basal.

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Yeah I think so.. I’ve been told I’m not eating enough carbs and not to do low carb diet as could develop ketones as body turns to burning fat for energy.. and if then have high sugars I can’t risk DKA again.. what do you think? It’s so confusing as so much different advice. All I know is I have less spikes and crashes when eat low carb meals and feel better.. and safer.

(Sorry for asking this I’m middle of your post btw)

boboblck said:

Yeah I think so.. I’ve been told I’m not eating enough carbs and not to do low carb diet as could develop ketones as body turns to burning fat for energy.. and if then have high sugars I can’t risk DKA again.. what do you think? It’s so confusing as so much different advice. All I know is I have less spikes and crashes when eat low carb meals and feel better.. and safer.

(Sorry for asking this I’m middle of your post btw)

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There’s a big difference between ketosis and ketoacidosis but out HCPs tend to panic when they see ketones - because in uncontrolled T1s they usually mean trouble. But as long as you have insulin in your body, and your sugars are ok (which they are more likely to be if you low carb), then I believe it’s pretty safe. Certainly safer than the swinging highs and lows we can get with high carb intakes and correspondingly high insulin doses. Like you, I feel much safer - what Dr Bernstein refers to as the Law of Small Numbers. Much less chance of making big mistakes. I’ve had two near fatal DKAs, so I understand the worry, but as long as I keep on top of my sugars, and my basal in particular, I’m happy. I test ketones most days (my consultant says he’d prefer it if I stayed out of ketosis, because he has to say that but gave me a prescription for plenty of strips to enable me to keep a close eye on it!) and usually run between 1.5-2.5mmol on a blood test.



Aplologies for hijacking your thread, @SueJB x

SueJB said:

This is my oversimplification
Too much insulin = hypo
Too little insulin = hyper
@Draco16 you say that "I would not say 8u is insignificant" and this is echoed by @slip but this doesn't seem to be confirmed by @Mel dCP taking 17u who's "goldmine" as @kitedoc puts it dried up in 1998. I'm now confused by all of this and what @boboblck has said about reducing bolus should bring down basal.

In fact I thought I understood the numbers and now I'm really not at all sure and could cry and wish I hadn't asked the question in the first place. Stressing

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Aw don’t stress. I think the point is there is lots of ways to manage this. If you eat healthy and workout a bit, your body will decide what numbers work for you. Keep doing what you doing. Play around with insulin slightly yourself to see what numbers you settle at. Everyone is different so you can listen to others stories for some guidance but it’s your body and ultimately your trail and error is going to be the answer. I’m doing the same, experimenting and seeing what works.

Good luck! And don’t worry, you are doing all the right things. Good numbers and healthy diet.


Xxx

Hi Sue, I think you may be stressing unnecessarily and getting caught up in the idea of the dosing formulae following a logical pattern for all of us.
The longer I’ve lived with T1 and the more I’ve seen of other people’s needs, the more convinced I’ve become that we’re all individual and can vary hugely.
I’d be very wary of altering your basal unless you find yourself having too many hypos which aren’t created by overdosing with bolus. The basal is there to ensure that vital organs have enough energy to function and thus we keep ticking along. If you think of insulin as being like a key that opens the door for energy to enter a cell then this might help explain why we need a constant supply so that our brains, liver, kidneys, heart, muscles, et al continue working. If your 8u works then that’s good. You may find that you need to reduce it if you lose weight or become more active. You may need to increase it as the honeymoon progresses, if you’re ill or if you step on the cracks in the pavement - sometimes this T1 thing throws a funny wobbly . The basal is individual to each of us.
Bolus is to deal with the food we eat. But you know this already.
Please forgive me if I seem just to be stating the obvious!
I think the root of the problem is that you want to lose weight and are struggling to find ways to do so. It’s so frustrating isn’t it when the lovely slim feelings begin to go. I clearly remember that brief two months before diagnosis when I felt my weight was perfect. Looking back, I was probably too skinny.
The most efficient weight loss experiences I had post diagnosis were getting amoebic dysentery (I don’t recommend that); picking up a tapeworm (I don’t recommend that), and having two colon-investigation things - starve for 36hours and do the Princess-Di-Type clearing (I really don’t recommend that); regular acquarobics and swimming lengths (I do recommend that!!!!); lots of walking (yup, really recommend this, and great for mood and bs control), and the 5:2 diet (this worked for me).
I eat about 90 - 110 carbs a day, though it varies, so knowing a bolus ratio’s vital. I use Levemir as a basal, 8.5u am and 8u pm, and novorapid as a bolus, ratio 1:1. When I was using Lantus I had 14u pm, but it didn’t last the 24hours. Despite this I was getting hypos with it because for me the profile was full of peaks and troughs. Some people find it works fine for them. We’re all individual and the key is to find what works for you.
Try not to get too hung up on what doses etc ‘should’ be and think of yourself as an individual crafts-person made piece of art: the way you put your own components together will come from a greater understanding of how your own fine and valued materials work.
You’re doing really well so far. The honeymoon’s not easy but you seem to be making it through with blood sugar results that look perfect. Wow!
You may be upset about weight gain now but I expect that once this initial phase of the evil fairy T1’s done you’ll get that equally sorted.

SueJB said:

This is my oversimplification
Too much insulin = hypo
Too little insulin = hyper
@Draco16 you say that "I would not say 8u is insignificant" and this is echoed by @slip but this doesn't seem to be confirmed by @Mel dCP taking 17u who's "goldmine" as @kitedoc puts it dried up in 1998. I'm now confused by all of this and what @boboblck has said about reducing bolus should bring down basal.

In fact I thought I understood the numbers and now I'm really not at all sure and could cry and wish I hadn't asked the question in the first place. Stressing

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Basal is individual so on this thread alone we have yourself at 8u, me at 13u, Mel 17u... reading other recent posts I can see people on anything from 4 to 34. There will be higher and lower!

You seem to have your basal spot on as you are achieving brilliant fasting and pre meal results. If you were taking excess you would be running hypo.

Now broadly we have to balance
Insulin, Food, Activity = BS

If an unwanted side affect is weight gain then decreasing food intake and increasing activity is the way to go, and this will also lower your insulin needs.

Also consider the types of food and activity (I find HIIT brilliant - High Intensity Interval Training - less duration but higher effort. Also you mention aerobic exercise, but weights are great also: pick up a couple of light dumbells or a kettlebell and get a little routine going with those).

Fairygodmother said:

Try not to get too hung up on what doses etc ‘should’ be and think of yourself as an individual crafts-person made piece of art: the way you put your own components together will come from a greater understanding of how your own fine and valued materials work.

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This is probably the best analogy of diabetes management I think I have seen so far. It’s perfect.

I’m surprised at how little basal I currently need to take, but it’s purely down to my <30g keto diet. Before I made that switch I was on 36-40 units a day. It’s been more in the past.

There’s a right dose for all of us for the time being. But as our bodies change - end of honeymoon, pregnancy, weight change, menstrual cycles, menopause - even life changing events like house moves, divorce, bereavement, and seasonal changes; our insulin needs change as well. Even the quality of our sleep can change insulin requirements.

Your BG levels indicate you’ve got your basal bang on for the moment, you’re getting numbers I’d be happy with. But I can understand the frustration with weight - I’m pretty hacked off with my own seeming inability to lose anything significant (and I’m about a stone heavier than I want to be). I keep reminding myself that good BG is the most important thing for my long term health, but it’s not easy to accept when so many others are losing weight effectively using this way of eating, and it’s easy to blame the insulin. Wish I had the answer

Sue - Could the weight gain be associated with muscle gain? Just a thought!

Just thinking on it over my umpteenth coffee of the morning, have you been measuring as well as weighing? Sometimes we don’t lose weight, but we do lose inches.

Bl**dy exasperating, though, innit? Happy to chat if you want to PM x

Well done @Fairygodmother and @Mel dCP such supportive logical answers and top class support. Good people to have in your diabetes corner.