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Only Bolus, No Basal

tpaz

tpaz

Well-Known Member
Messages
173
Location
Canada
Type of diabetes
Type 1
Treatment type
Other
Dislikes
Cardio exercise
hi everyone,

I was confirmed as T1 about 1 month ago (according to my endocrinologist LADA and T1 are the same thing). I've been on Metformin now for about 8 months. Just started on insulin for a week now.

I've only been prescribed NovoRapid to take with meals, and only of I'm eating 30g or more of carbs within that meal. In addition to this, for now I can only take 3 units - no matter the carb count.

I've been reading everywhere that NovoRapid is really to be used in addition to basal insulin as well. Should I be concerned or should I trust that the doctor knows what's she's doing?

She had initially threatened to not give me any insulin at all, suggesting that I "work out too much and don't eat enough carbs". I was doing those things because it was the only way to control my levels without insulin!
 
I worked out a lot and ate very low carb and now I just take very small doses of insulin but I do need basal. Just one unit. I upped carbs when 1 st put on insulin but didn't work so lowered carbs and insulin. 1/2 unit per small meal. All is well

I had to work out after every meal and eat extremely low carb and very small meals to keep BS Louise. They don't get how little we need to eat to keep low. That is not normal. That is LADA.

are you of low BMI as well? Recent weight loss?
 
Kristin251 said:
I worked out a lot and ate very low carb and now I just take very small doses of insulin but I do need basal. Just one unit. I upped carbs when 1 st put on insulin but didn't work so lowered carbs and insulin. 1/2 unit per small meal. All is well

I had to work out after every meal and eat extremely low carb and very small meals to keep BS Louise. They don't get how little we need to eat to keep low. That is not normal. That is LADA.

are you of low BMI as well? Recent weight loss?
Click to expand...

I'm actually on the higher side of normal bmi, I've struggled with my weight my whole life. I think I'm just shy of a bmi of 25. I've been trying to lose weight on purpose in the last month, anticipating starting insulin and gaining some, but I can't seem to lose anything other than a couple of lbs.
 
Kristin251 said:
I worked out a lot and ate very low carb and now I just take very small doses of insulin but I do need basal. Just one unit. I upped carbs when 1 st put on insulin but didn't work so lowered carbs and insulin. 1/2 unit per small meal. All is well

I had to work out after every meal and eat extremely low carb and very small meals to keep BS Louise. They don't get how little we need to eat to keep low. That is not normal. That is LADA.

are you of low BMI as well? Recent weight loss?
Click to expand...
I find that on days where I don't work out, my Bg levels stay above normal for longer. So I will stay at 6.5 mmol, for example, for hours and hours. On days I do work out, I'm easily below 6 mmol.
 
All I can say is keep carbs low with insulin and you will need less and shouldn't gain. Bear in mind insulin is a fat storing / growth hormone. low carb and low insulin will take you very far with weight loss if that is your goal.

Edited by a mod to remove unproven information
 
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Kristin251 said:
All I can say is keep carbs low with insulin and you will need less and shouldn't gain. Bear in mind insulin is a fat storing / growth hormone. Low carb and low insulin will take you very far with weight loss if that is your goal.
Click to expand...

Can I ask you how you take 1/2 unit? My pen's minimum amount is 1 unit.

Edited by a mod to update quoted post
 
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My lantus only goes as low as 1 and I need a fat snack before bed so I don't go lower. Usually a bite of PB and celery and I still end up a tad lower but my novolog is in half unit pens. I had to buy the pen seperatly but I need it. There is a huge difference for me between 1/2 and 1
 
tpaz said:
Can I ask you how you take 1/2 unit? My pen's minimum amount is 1 unit.
Click to expand...
Hi. I have a 1/2 unit NovoNordisk Echo pen 4 for my NovoRapid. This is a replaceable cartridge pen not the disposable; not sure if they also come in a 1/2 unit form. May be worth asking the doc to swap you to a replaceable cartridge pen? My nurse offered me a choice of which type to use. It sounds like you are in the early days of islet cell failure and it's not obvious whether you should be on Basal as well as Bolus, but normally you would start with Basal first as I did and then add a Bolus as my nurse did after 2 months when she saw control wasn't good enough.
 
For a half dose, you need the Echo pen.

I would go with your consultant here. It's our phase one, immediate insulin function that goes first, and that is what quick-acting insulin replaces. You probably will need basal as well, but bolussing will fix you quicker. I think you're quite lucky actually: usually we just get given basal, and its not enough to fend off the damage that post-meal spikes do.
 
Welcome to the club. NovoRapid is a good start, basal can be added later. I also use the NovoPen Echo ( thanks @LucySW ) and I find it indispensable.

Your doctor is right about making sure to eat enough carbs if you inject 3 units of insulin. Especially true if you work out.

When I was started on NovoRapid, I would take just 2 units and would still hypo occasionally, especially when injecting e.g. 20 mins before eating. I think the remnants of my own insulin capability caused this, combined with NovoRapid.
 
If I am going to inject more than 1unit I need to eat some carbs. I'm not talking a bag of chips but enough veggies. Protein comes in a little later so I have to bridge the gap so to speak or I will go low 1 st then pop up.
 
cz_dave said:
Welcome to the club. NovoRapid is a good start, basal can be added later. I also use the NovoPen Echo ( thanks @LucySW ) and I find it indispensable.

Your doctor is right about making sure to eat enough carbs if you inject 3 units of insulin. Especially true if you work out.

When I was started on NovoRapid, I would take just 2 units and would still hypo occasionally, especially when injecting e.g. 20 mins before eating. I think the remnants of my own insulin capability caused this, combined with NovoRapid.
Click to expand...

I have yet to experience a low... Even when probably not eating as much as I thought I would be. So I've had a pre meal in the 5.5 mmol range, had 3 units, and then maybe 15g of carbs and post meal reading was still in the 5's. I am also on Metformin though, so maybe I'm insulin resistant as well?
 
Daibell said:
Hi. I have a 1/2 unit NovoNordisk Echo pen 4 for my NovoRapid. This is a replaceable cartridge pen not the disposable; not sure if they also come in a 1/2 unit form. May be worth asking the doc to swap you to a replaceable cartridge pen? My nurse offered me a choice of which type to use. It sounds like you are in the early days of islet cell failure and it's not obvious whether you should be on Basal as well as Bolus, but normally you would start with Basal first as I did and then add a Bolus as my nurse did after 2 months when she saw control wasn't good enough.
Click to expand...

I am in the "early stages"

Somewhat, anyways. I was diagnosed at 19 and told that I was type 2. No additional testing or other doctors. 12 years later I finally get sent to an endocrinologist and blood test confirmed I am type 1, but not severely progressed. I can't tell you how I've managed to honeymoon for so long. Lol.
 
LucySW said:
For a half dose, you need the Echo pen.

I would go with your consultant here. It's our phase one, immediate insulin function that goes first, and that is what quick-acting insulin replaces. You probably will need basal as well, but bolussing will fix you quicker. I think you're quite lucky actually: usually we just get given basal, and its not enough to fend off the damage that post-meal spikes do.
Click to expand...

Thank you. I don't think I've ever been to a doctor of any sorts for a second opinion, so I wasn't sure if I should be asking my GP for that. Your comment put me at ease.
 
When are you seeing the endo again?

Working out and eating low carb are the RIGHT thing to do. But with LADA (which is more or less just late-onset Type 1, with a much more gradual onset), eventually that isn't enough, so it's great that you now have the diagnosis and the Metformin and the bolus to use when you need it.

Just decide what levels BG you want to aim for, and bolus as you need to to maintain those levels. Bearing in mind that keeping carbs to <30 grams/day will keep the spikes lowish and consistent, so you'll avoid big rebounds. The endo's concern will be above all to avoid big rebounds leading to low BG or hypos. If you document and manage your BG steadily, you may allay her fears.

Of course we shouldn't attempt to advise you, we can only offer our experience. I'm a honeymooning LADA and I aim for 4.6 before meals and 5.6 within 2 h of eating, then down again. (I often fail, BTW.)

I really would advise you to read Dr Bernstein's book. His way doesn't suit everybody, but it has suited - and saved - tens of thousands of people. He is the greatest diabetes clinician.

https://www.amazon.co.uk/gp/aw/d/03..._SX110_SY165&qid=1439482271&ref=plSrch&sr=1-1

And his Diabetes University playlist online:

https://m.youtube.com/playlist?list=PLs_TA02I6IvV6-1s2pL4BPhvMo0Ck_lcY
Metformin plus insulin is good. Just ease off the alcohol.
 
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I actually like the idea of a bolus-only insulin therapy for a type 1.5.

Usually, your insulin production is high enough to regulate your fasting levels. Consequently, basal insulin wouldn't be necessary (aside from the possible effects of preserving your beta cells further).

The issue is generally that people don't have enough insulin to cover their meals which can result in hyperglycemia that takes some time to drop. If you think about it, that acts similar to insulin resistance which is why type 1.5 is often misdiagnosed.

Personally, I'd much rather have a bolus insulin pen than a basal pen (if I had to choose). Also, as others mentioned get the Echo pen if you can. The .5 unit increments are very helpful for correcting.
 
tpaz said:
I have yet to experience a low... Even when probably not eating as much as I thought I would be. So I've had a pre meal in the 5.5 mmol range, had 3 units, and then maybe 15g of carbs and post meal reading was still in the 5's. I am also on Metformin though, so maybe I'm insulin resistant as well?
Click to expand...
Not necessarily. Since you are not on basal, your bolus also partly covers your basal needs and not just the carbs you eat.
 
tpaz said:
hi everyone,

I was confirmed as T1 about 1 month ago (according to my endocrinologist LADA and T1 are the same thing). I've been on Metformin now for about 8 months. Just started on insulin for a week now.

I've only been prescribed NovoRapid to take with meals, and only of I'm eating 30g or more of carbs within that meal. In addition to this, for now I can only take 3 units - no matter the carb count.

I've been reading everywhere that NovoRapid is really to be used in addition to basal insulin as well. Should I be concerned or should I trust that the doctor knows what's she's doing?

She had initially threatened to not give me any insulin at all, suggesting that I "work out too much and don't eat enough carbs". I was doing those things because it was the only way to control my levels without insulin!
Click to expand...

my situation is very similar to yours,diagnosed type july last year.First I was only on basal but within a month was off it all together due to hypos on very little insulin,still not on anything...long live my pancreas.
 
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