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Twice a day injections versus Basal/Bolus regime

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Hi just thought id put a quick thread on here iam curious for type 1s how many are stil on the old fashioned twice a day regime compared to the Basal/Bolus. Been diabetic for aproximately 22 years up untill bout 4 years just had lots of insulin and just ate regular i could eat a full chinese for supper with rice chips etc just on 2 injections a day and still woke up with sugars between 4/5 in the morning so must admit was proberbly on alot of insulin. I tried the Nova rapid/lantus levir etc and for me just didnt like it. Done the dafne course and for me personally didnt really help to much. Eventually i lost alot of weight aproximatley a few stone as i couldnt get to grips with the bolus regime. I know what carbs in foods etc etc but eventually having an HBA1c of 10% for a few years opted to go back on the Humiln M3 twice a day. It may not be convient for alot of people but i like to keep in sort of routine. One thing i did find on the nova rapid etc i could get ketones very easy when my sugars etc were say around 11 i found that very confusing also found the rapid was very strong and small amounts of activity could crash my sugars. My sugars are way off but slowing increasing my Humilin without over eating all the time, But what iam curious about is sometime when my sugars go into the 20s i dont get ketones. Went to have my eyes checked again and still seem ok no surgey etc. Iam finding people that have had diabetes for less time and possibly better HBA1cs than 10 percent having problems. What iam sorting saying is how bad is 2 injections a day for diabetics and especially newly diagnosed. For me as a ten year old i did my injections ate at set times and snacks then had abit of chocy when felt really hungry and thats how i sort of managed it for years. The newer basal bolus regime for especially newly diagnosed diabetics must be a huge task to understand from carbs the activity you do plus your body changing all the time. My personal opinion would be for newly diagnosed diabetics put on twice a day to start of and progress to the more complex regimes as you learn and understand it more. Just my opinion thanks for looking :D
 
DannyH said:
Hi just thought id put a quick thread on here iam curious for type 1s how many are stil on the old fashioned twice a day regime compared to the Basal/Bolus. Been diabetic for aproximately 22 years up untill bout 4 years just had lots of insulin and just ate regular i could eat a full chinese for supper with rice chips etc just on 2 injections a day and still woke up with sugars between 4/5 in the morning so must admit was proberbly on alot of insulin. I tried the Nova rapid/lantus levir etc and for me just didnt like it. Done the dafne course and for me personally didnt really help to much. Eventually i lost alot of weight aproximatley a few stone as i couldnt get to grips with the bolus regime. I know what carbs in foods etc etc but eventually having an HBA1c of 10% for a few years opted to go back on the Humiln M3 twice a day. It may not be convient for alot of people but i like to keep in sort of routine. One thing i did find on the nova rapid etc i could get ketones very easy when my sugars etc were say around 11 i found that very confusing also found the rapid was very strong and small amounts of activity could crash my sugars. My sugars are way off but slowing increasing my Humilin without over eating all the time, But what iam curious about is sometime when my sugars go into the 20s i dont get ketones. Went to have my eyes checked again and still seem ok no surgey etc. Iam finding people that have had diabetes for less time and possibly better HBA1cs than 10 percent having problems. What iam sorting saying is how bad is 2 injections a day for diabetics and especially newly diagnosed. For me as a ten year old i did my injections ate at set times and snacks then had abit of chocy when felt really hungry and thats how i sort of managed it for years. The newer basal bolus regime for especially newly diagnosed diabetics must be a huge task to understand from carbs the activity you do plus your body changing all the time. My personal opinion would be for newly diagnosed diabetics put on twice a day to start of and progress to the more complex regimes as you learn and understand it more. Just my opinion thanks for looking :D
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Hi and hello Danny :wave: Like you I have had diabetes for over 20 years, type 1. I started off on the syringes with 2 injections a day. I am on NovoRapid quick acting and Levemir insulin, before bed, so I take between 4 and 5 injections per day.

I can understand you wanting to go back to the two injections because it seems to be working so well for you :thumbup: well done. Thats agood idea of yours to start on 2 injections first, its a lot to take in and can be very scary to new people knowing that they will have to inject for the rest of there lives :( until a cure can be found). Obviously this may not be the right medication for all, but it could work well for others. Thanks for the great post. With best wishes RRB
 
I disagree. Twice daily insulin regimes are a lot less flexible than basal bolus, and forcing all newly diagnosed diabetics to drastically change their lives just because you personally are struggling with it is... dumb. I'm sorry you were struggling with basal bolus, and I'm glad you're doing better (but I'm not sure how much better since you listed " no ketones at BG of 20 mmol/l" as an advantage of twice daily mixes...)

At diagnosis, the patient and the doctor should discuss the available options and pick the most appropriate one, which could well be twice daily.

The simple fact is that basal bolus regime is more flexible: you can vary size and time of meals (there is no reason you cannot have a Chinese takeaway), you don't have to have snacks if you don't want to, and you can correct for high BG more easily.
Further, the argument that DAFNE is too complicated is a straw man - whilst basal bolus regime is often used with carb counting (which DAFNE teaches), it's perfectly possible to continue eating fixed meals; this would eliminate most of the complexity whilst keeping some of the benefits and allow progression to the more flexible carb counting system if and when the patient feels ready for it.

Basal bolus is not exactly rocket science: if post meal reedings are high, take more Novorapid; if they're low, take less. If fasting BG is high, take more basal insulin; if it's low, take less. I'll see if I can find the leaflet with the flow chart for that.
It's not inherently more likely to result I ketones than any other regime; in fact, if I was to venture a guess I'd say that your basal dose was on the high side when you were on twice daily (Chinese takeaway has a lot of carbs, so you'd need a high dose of mix, thus high basal) but too low on basal bolus.

Edit to add: found it

For the record, I was diagnosed last year, learned 95% of what I needed to know in 2x 2h chats with the DSN whilst stuck in the ICU, and have maintained an HbA1c of 5.8% ever since. Again, it's a matter of finding the most appropriate treatment for the patient - choices = good
 
If a persons medical regime is working well for them that's great and they are happy with it and no complications, then stick with it :thumbup: It appeared Danny was just giving his views on what could happen to a newly diagnosed diabetic as when he was first diagnosed it worked for him. Different things work for different people ( still hoping for that cure though) :D RRB
 
Thats a great HBA1c at 5.8 mines probably double that at the min coming down gradually though. I was just putting my opinion. I never said dafne was hard i pretty much know what carbs are in each food and how it can effect sugars etc. Just think alot of diabetics now are putting far much pressure on themselfs. Ive read when some one has put an article on because there sugars have gone up from 7mmol to 9mmol. Iam 31 now and pretty much drank alcohol for 10 years and so i also smoke which isnt very clever but i do try and watch certain things i eat etc. Like i said having the 2 injections for me made me think about meals times etc at an early age and its not a big deal eating at similar times during the day.. Ok its not very flexible but hey i like routine lol. But as for me ive sort trying my own rountine out. I have 2 injections a day i know pretty much where my sugars are, but ive decided to get the nova rapid on perscription. So what i do is have the 2 injections and if poorly and if i must i can have the odd unit or 2 of the rapid. that way on good days il have the 2 injections and i can always get my sugars down if i must. but like i said this is a gradually process. All i was trying to point out is young newly type ones these days must be like a mine field trying to think of everything to balance it out.
 
As the two injections are working for you Danny then stick with it, I suppose basal/bolus isn't for everyone but personally I do enjoy the flexibility of basal/bolus .
 
Further, the argument that DAFNE is too complicated is a straw man - whilst basal bolus regime is often used with carb counting (which DAFNE teaches), it's perfectly possible to continue eating fixed meals; this would eliminate most of the complexity whilst keeping some of the benefits and allow progression to the more flexible carb counting system if and when the patient feels ready for it.
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That's what I was taught to do, I had a prescribed amount of carbs for each meal and a rapid bolus which could be adjusted according to glucose levels/prior exercise etc. I was taught to adjust basal as a result of between meal and fasting levels.
It meant it was very easy to move to being more flexible about meal timing/content. As a creature of habit I tend to stick to fairly regular meals but I'm able to also cope with the feast and famine days.
 
At diagnosis I was one who passed out at the sight of a needle, so they wisely decided to put me on twice daily. :clap:

This worked well for getting me accustomed to the new world, but it has its downside. With time I have moved myself to basal bolus (no 2 days are the same in this house). Consequently I missed the education that goes with adopting basal bolus. I have been floundering along, grasping the basic carb:insulin ratio but never quite sure what to do when it went wrong and as honeymooning is coming to an end, the need for accuracy and correcting is getting greater.

The link AMBennan put in is a godsend. Thank you for it. I'm sure I was told some of it, but of the 8 hours in hospital, there was only 30mins with the DSN to explain what to do and the follow-up education wasn't great (I admit I didn't help as I was spikey about being left with medication I didn't understand; I like to be in control and the DSNs probably found me resistant to doing what I was told without knowing why).

I think there is a great need for better diabetes education when first diagnosed and trying to "choose" your regime and manage the little hiccups that crop up. My sincere thanks to all of you who post info here, it helps to nudge me back into line on a weekly basis.

I hope to pay it back for others ... when I know a little more!
 
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