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Moved onto basal bolus, help!

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pruk

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Hi guys,

So a diabetic for 21 (wow that's a long time!) years and I have finally caught up with modern life and been put on a basal bolus mix (levimir and novo rapid).

I am struggling with the change and was wondering if anyone had any tips. The nurses are supportive but have thrown me in at the deep end, they want me to be very strict and keep to the insulin levels they suggested but it just isn't enough, for example I am on 3 novo rapid injections but I have not been told to take one when I have supper in the evening making my sugars high in the morning and for most of the next day!

Any advice? Thanks in advance :)


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I disagree with the nurses' approach. The whole POINT of basal/bolus is to eat what you want, when you want, and take an appropriate level of insulin.

The general idea is that you give yourself 1 unit of Rapid for every x grams of carbohydrate, for a type 1 diabetic it's typically something like 8-15g. Many people find that the ratio is different in the morning, midday and evening (due to your body clock). So you may find you need 1unit : 12g for breakfast, 1unit : 10g for lunch, etc.

NovoRapid lasts about 4 hours, so you generally figure out whether your dosage was too high or low by what your readings are like about 4 hours later (of course this is thrown off if you have another meal in that period, maybe that is what the nurses are trying to avoid, but IMO it's not a big deal, you'll figure things out).

Levemir is trickier to work out, the idea is that if your sugars tend to go low or high when you haven't got food or NovoRapid in you you need to adjust the Levemir.

Good luck!
 
Hi Pruk,
I'd get back in touch with the DSNs and explain about the supper and ask to get on a DAFNE course or a local carb counting course if there's no dafne in your area. I tend to have a no-carb supper so I don't need to inject for it and that might help you til you get it sorted. Good luck.
Please ignore the well meaning but ignorant and dangerous advice for type1s from jason32.
 
The whole principle of basal/bolus is so that you can adjust your insulin to the food you eat, so if you wanted to eat a meal of 30g or 70g you just bolus the insulin accordingly.

The following is an on-line version of DAFNE which Rockape mentioned earlier, it will give you some knowledge of how basal/bolus works and should get you started:

http://www.bdec-e-learning.com/
 
I agree that the nurses advice seems strange. My nurse started me on Levemir and sensibly told me to adjust the level to have a morning fasting level or around 6mmol. She suggested I started with 10 units and in fact I now take 9 units and have a sugar level of 4-5 in the morning. A few weeks later she added NovoRapid and handed me a Roche leaflet for carb counting and suggested I try 1 unit per 10gm and adjust from there. So I'm lucky in having an enlightened nurse who knows that Rapid insulin should best be adjusted to meal carb content. She assumed I would use common sense and take the rapid before any meal with a reasonable amount of carbs. For the first week or so I was asked to email my sugar readings so we could discuss any changes in carb to insulin ratio. So, in summary I would try to get the nurse onside by indicating tactfully that you know of others who carb count. If she resists I think you will need to make you own decisions but whatever you do measure watch out for hypos.
 
Good advice already given but just wanted to add to the second poster try googling type 1 diabetes, and reading the info.

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