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How would me a type2 on insulin do to reduce my basal insulin? bolus units decreasing nicely.

ickihun

ickihun

Master
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13,696
Location
Sunderland
Type of diabetes
Type 2
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Insulin
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Hi all MDI users.
How can I reduce my basal insulin need? I've reduced my bolus units nicely.
Should I be reducing basal too resulting in more bolus need til I can reduce bolus more again?
My only concern is I'm losing weight nicely and don't want to confuse that. That is my priority as my bgs are good and last hba1c was 48.

Any ideas welcome, from type1s or type2s.
 
Hi. In principle you would reduce the Basal shots as needed to still maintain a good BS figure. This should only be done gradually over a few days and test along the way; at least reducing Basal doesn't risk hypos. Your Bolus ratio shouldn't change much but it sounds like you have been having fixed shots rather than carb-counting and using a ratio. If you have been using fixed Bolus shots then these would be gradually reduced, again using the meter to ensure your BS doesn't go too high. I note that you have various medical conditions so do seek guidance from the DN as necessary and discuss carb-counting if you are not doing that already.
 
ickihun said:
Hi all MDI users.
How can I reduce my basal insulin need? I've reduced my bolus units nicely.
Should I be reducing basal too resulting in more bolus need til I can reduce bolus more again?
My only concern is I'm losing weight nicely and don't want to confuse that. That is my priority as my bgs are good and last hba1c was 48.

Any ideas welcome, from type1s or type2s.
Click to expand...
Hello @ickihun :) Are you wanting to know what is the best practice to gradually reduce your basal dose (i.e. in what increments) or are you asking how to make your body physically require less basal insulin?
 
GrantGam said:
Hello @ickihun :) Are you wanting to know what is the best practice to gradually reduce your basal dose (i.e. in what increments) or are you asking how to make your body physically require less basal insulin?
Click to expand...
Body physically require less, ideally.
 
Thanks.
I've been reducing insulin for months now but having a mild block about how my basal is ready to be reduced. I'm not having hypos, which used to be my only motivation to reduce my insulin.
Could I be running out of limitation to reduce even though bolus only 10units or 15units per meal?
I like the good idea to do a basal test. Thank you.
 
Hi @ickihun . The only 2 things that influence are......
1. Work days.3 units less in the morning than any other time of the week. Mon to Thurs 15 units a.m. Fri to Sun a.m. and every evening 18 units.
2. Actual body weight. Depending on body weight, which I usually alter by choice ( or try to:)) with different exercise regimes. If my body weight was to increase by 6 to 7 kg then the numbers above would increase by 2 all round.
Not sure this helps you but it's important that you keep your basal levels at the required level to maintain good control, lowering basal intake to the detriment of good control is not a wise move, but I'm sure you already know that:).
 
therower said:
Hi @ickihun . The only 2 things that influence are......
1. Work days.3 units less in the morning than any other time of the week. Mon to Thurs 15 units a.m. Fri to Sun a.m. and every evening 18 units.
2. Actual body weight. Depending on body weight, which I usually alter by choice ( or try to:)) with different exercise regimes. If my body weight was to increase by 6 to 7 kg then the numbers above would increase by 2 all round.
Not sure this helps you but it's important that you keep your basal levels at the required level to maintain good control, lowering basal intake to the detriment of good control is not a wise move, but I'm sure you already know that:).
Click to expand...
I will do a basal test and if no alteration then I'll try and increase walking or burning energy more everyday, somehow.
Coming up to bad weather my running machine may need a service before relying on it to keep me moving in winter. The frost and wind terrifies my unbalanced painful walking.
 
You need to basal test.

Previously did you run on a 50/50 ratio or what are you running at now with basal/bolus?

Have you got 1/2 unit pens?

You need to basal test before adjusting really.

The rule of basic thumb used to be :if levels high or low 2-3 hours after bolus then its your bolus to change. At all other times its you basal.. however this does not account for wrong details such as acting time or offset times...
 
ickihun said:
Body physically require less, ideally.
Click to expand...
I guess if you need more basal insulin as a result of insulin resistance, then finding a way to overcome the resistance would be beneficial.

But, from the above - I may as well have told you to "if you cure your diabetes; you'll need less insulin". It's pretty much the same thing... Really sorry I can't be of much help.

I'm not all that sure of your situation regarding exercise, but I know that it's very beneficial for all diabetics as it allows for insulin to remove glucose from the blood stream and store it easier. Something fancy to do with GLUT4 receptors/transporters. I know that I need less insulin when I've been doing a lot of exercise, so you may find that helps with your insulin resistance and could potentially lower your basal dose @ickihun.
 
So basal is the hardest to influence, when trying to lose weight on mdi?

I'm now less weight than when I was in burnout before an insulin regime (other than 2 pregnancies).
I'm on mdi and metformin compared to pre-burn out with tablet meds only. Glaclizide must have been adding weight, afterall.
Maybe metformin works better for me without glaclizide and others, for weight loss.
I'm desperate to keep losing my further 10stones to lose but I'd accept a stale mate, under grudge.
I'm getting help with my back so more exercise may eventually be on the cards. I'd like it to be pre bariatric surgery thou.
 
Remember that allowing your BG to be in the high single figures for a few weeks has little long-term harm.

As a Type2 losing weight fast
  • You insulin resistance will be decreasing every day
  • You panaceas may become able to produce more insulin.
  • Having to eat carbs due to a hypo will be very unmotivating on your diet
A basal test is worth doing, but the results may not be valid for that many days. If it was me I would reduce the basal insulin by a little and measure to see what effect it has without stressing too much if the BG goes into the 7 or 8 range. Likewise provided the hba1c remains under about 60, long-term losing fat will give must more benefit, then stressing about the risk of a little increase in hba1c.

Recent research has shown that there is no benefit from "tight BG control" for people with Type2 using insulin, compared to "lose BG control" - sorry I can't remember the numbers they used to define "tight control".

The exercise of the most benefit per minute is “resistance training”, there are lots of page on the internet about how to do this just using your own body weight at home. The next most benefit comes from high intensity internal training . Walk at a speed you are happy with on your running machine for 10 minutes then put it up to the heist angle you can cope with for 2 minutes, then back to flat for 5 minutes and repeat a few times.
 
donnellysdogs said:
You need to basal test.

Previously did you run on a 50/50 ratio or what are you running at now with basal/bolus?

Have you got 1/2 unit pens?

You need to basal test before adjusting really.

The rule of basic thumb used to be :if levels high or low 2-3 hours after bolus then its your bolus to change. At all other times its you basal.. however this does not account for wrong details such as acting time or offset times...
Click to expand...
I was 70/30 m3 now should be 50/50 but have reduced bolus due to hypos which are no longer and post bolus readings excellent and ticking along defending liver dumps my levels pre-food excellent too. In times of missing a meal my basal ticks me along lovely.
I'll still do a full basal test though. All meals for 2-3days to get a fuller picture.
 
ringi said:
Remember that allowing your BG to be in the high single figures for a few weeks has little long-term harm.

As a Type2 losing weight fast
  • You insulin resistance will be decreasing every day
  • You panaceas may become able to produce more insulin.
  • Having to eat carbs due to a hypo will be very unmotivating on your diet
A basal test is worth doing, but the results may not be valid for that many days. If it was me I would reduce the basal insulin by a little and measure to see what effect it has without stressing too much if the BG goes into the 7 or 8 range. Likewise provided the hba1c remains under about 60, long-term losing fat will give must more benefit, then stressing about the risk of a little increase in hba1c.

Recent research has shown that there is no benefit from "tight BG control" for people with Type2 using insulin, compared to "lose BG control" - sorry I can't remember the numbers they used to define "tight control".

The exercise of the most benefit per minute is “resistance training”, there are lots of page on the internet about how to do this just using your own body weight at home. The next most benefit comes from high intensity internal training . Walk at a speed you are happy with on your running machine for 10 minutes then put it up to the heist angle you can cope with for 2 minutes, then back to flat for 5 minutes and repeat a few times.
Click to expand...
I cannot walk up hills. Its like climbing mount everest for me and very very painful, kicking asthma attacks if not careful. I have to negotiate my routes to avoid steep hills. I can only walk at a snails pace due to bulging discs, scatica and investigating neuropathy (unbalanced walking). I'd just have to walk longer at home on machine, if possible, on days when possible around pain and capability. Which I will try and do. Asthma control permitting too.
I'm all for increasing fitness, safely.

So more exercise, if possible it is.
Wish me luck!

As I like @Kristin251 get spikes from strenous exercise/pain.

Hubby has promised a swimming pool visit aided next weekend. Fingers crossed I don't slip like one poster who damaged her shoulder and is still off work. :confused:
I want to continue losing weight but won't risk more a&e time to do it.

Basal tests start tomorrow!

Ps. I dont use carb foods to treat a hypo, i use gluco tabs. My liver assists too.
I've had a few somogyi effect moments through the nights when first on toujeo300 basal, but none for weeks.

Thanks for insight.
 
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