Insulin regime change from mixed insulin to basal bolus

Geminigirl

Well-Known Member
Messages
165
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Spicy food, 2 faced people.
Hi all,

Finally had my meeting with the Senior DN at my hospital's diabetes clinic.

She agreed I might be better off switching from Humulin M3 to a basal bolus regime to give me more flexibility, especially where I want to miss a meal and/or reduce carbs a bit.

She is very supportive and has prescribed me Tresiba once a day and Trurapi before meals.

I feel a bit bombarded with info tbh and after thinking about what she said I'm confused by the dosages. Is it calculated on body weight?

I was using HM3, 44 units breakfast and dinner, 14 at lunch.

She has said start the Tresiba once a day, 50 units, then fixed dose of 15 units of Trurapi before meals. She said if I have a carb free meal, leave it.

When I saw the the Dietician straight after she said count my carbs (am happy to do) then calculate 1 unit of Trurapi to 5g of carbs.

I know you can't advise as such, but by these calculations the DN seems to think I consume 75g of carbs per meal? I certainly don't.

I don't want to "feed the insulin", that happens now sometimes.

I can't do very low carb due to taking Dapagflozin but the Dietician said as long as I have say some carb per meal I'm OK. Even a bit of fruit. No one can tell me the min carb while on the Dap.

The Dietician also talked to me about correction dose where my bg is higher than target before a meal. I get that, but didn't explain how many units per mmol.

Yes, I know I need to speak to them to clarify, just looking for anyone who might clarify some of it for me.

She said I can take the Tresiba am or pm, which is best?

I'm ready to grasp all this but am nervous, I wear the Libre 2 sensor, have it on script and have the app on my phone, also given permission to clinic for access.

Thanks for any input, wish me luck.

Chris
 
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Antje77

Guru
Retired Moderator
Messages
20,576
Type of diabetes
LADA
Treatment type
Insulin
I'm confused by the dosages. Is it calculated on body weight?
No.
Insulin doses are worked out by trial and error.
Find patterns. Overnight patterns, before and after meal patterns (preferably with a carb count), patterns around exercise.

In your case, you were on insulin already, so there is already a rough idea on how much insulin you need. (To give you an idea, some people only need 15 units in total a day, although those usually have T1 and are thin, others need over 300 units a day.)
Currently, you're on 58 units of insulin so there is a starting point from which your nurse is working, it doesn't make sense to expect you'll need less than that on a different regime.
She has said start the Tresiba once a day, 50 units, then fixed dose of 15 units of Trurapi before meals. She said if I have a carb free meal, leave it.

When I saw the the Dietician straight after she said count my carbs (am happy to do) then calculate 1 unit of Trurapi to 5g of carbs.

I know you can't advise as such, but by these calculations the DN seems to think I consume 75g of carbs per meal? I certainly don't.
I agree with your worries on overdosing here. It may well be that the DN assumes some 75g of carbs per meal if she's thinking eatwell plate, I like the dieticians thinking better.
The Dietician also talked to me about correction dose where my bg is higher than target before a meal. I get that, but didn't explain how many units per mmol.

Yes, I know I need to speak to them to clarify, just looking for anyone who might clarify some of it for me.
No one knows what your correction factor is at the moment, it's trial and error. Your CGM will be very helpful to find patterns.
In general, it isn't advised to do corrections until 4 hours after eating because you'll still have active insulin on board.
She said I can take the Tresiba am or pm, which is best?
With Tresiba, the longest acting of all long acting insulins it really doesn't matter, take it at a time that suits you!
I take it before bed, no matter if that's 10:30 pm or 5:30 am, it's a very forgiving insulin when it comes to timing. :)
Thanks for any input, wish me luck.
Much luck coming your way, I really hope that the freedom of a basal and bolus regime will make you as happy as it does me once you get the hang of it!
 

Geminigirl

Well-Known Member
Messages
165
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Spicy food, 2 faced people.
Thankyou! Think I'm allowing myself to over think it.

I think I'll start the carb counting and follow the dieticians advice.

It was a lot to take in.

Today I had a pre-op assessment for a throat surgery in 2 weeks time and they've postponed it until the end of March as I have to lose 3lbs in weight to get me under the BMI limit!

I've been trying hard to lose weight and have shed a stone, so the last thing I need is to eat for England lol.

Oh the joys! Lol.

Seriously, many thanks.
 
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Antje77

Guru
Retired Moderator
Messages
20,576
Type of diabetes
LADA
Treatment type
Insulin
Let us know how it goes with your new insulins and don't hesitate to keep asking questions!
We can't give dosing advice but we can share our thoughts and experiences, or relevant links.

I'm sorry to hear your surgery has been postponed over a mere 3lbs, especially after having managed to lose a stome already. I'll keep my fingers crossed for those last pesky pounds before the end of March.
 

Geminigirl

Well-Known Member
Messages
165
Type of diabetes
Type 2
Treatment type
Insulin
Dislikes
Spicy food, 2 faced people.
Let us know how it goes with your new insulins and don't hesitate to keep asking questions!
We can't give dosing advice but we can share our thoughts and experiences, or relevant links.

I'm sorry to hear your surgery has been postponed over a mere 3lbs, especially after having managed to lose a stome already. I'll keep my fingers crossed for those last pesky pounds before the end of March.
Hi Antje
I've spoken to the DN today and she has agreed I start the Trurapi at 1 unit per 5g of carbs 15 mins before meals to start with.
Take the Tresiba, 50 units at night.

Obviously it's a learning curve and as she says, everyone is different so the ratios can, and prob will change.

She's going to ring me next week to see how I'm doing, or I can ring her if I want to before that.

Thanks for your support, much appreciated.

Chris