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Which is best. More Basal or more Bolus?

Discussion in 'Type 1 Diabetes' started by Lord Midas, Sep 28, 2017.

  1. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    Hi everyone,

    Which is best. More Basal or more Bolus?

    What are your opinions on this question?

    I was reading Dr. Bernstein's book Diabetes Solution - A Complete Guide to Achieving Normal Blood Sugars and in it he says that people shouldn't be taking more than 7 units of Basal insulin. Now 've been Itaking 32 units of Lantus each night and this made me think "whoa". So I've started lowering my doses (of Lantus) but I think this has had a big impact on my BS during the day. It's also meant that I've had to take bigger doses of Bolus (Humalog) to get me back to good BS levels.

    I think that getting your BS stable with Basal first is most important, regardless if it seems like a huge dose. Then the Bolus becomes easier to manage.
     
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  2. GrantGam

    GrantGam Type 1 · Well-Known Member

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    That's the biggest load of rubbish I've ever heard in my life, sorry.

    I'm young, fit and very active. I require 18u of basal. That figure barely changes whether I'm eating carbs or not.

    You take as much basal as your body needs and that's really all there is to it. You can tell your liver to only produce enough glucose for 7u of basal to cover in a 24 hour period, but I doubt it would listen.
     
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  3. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    I was skeptical too. A lot of what he says is good, but the basal he talks about might have been from decades past. I can sure say that 7 for me doesn't work.
     
    #3 Lord Midas, Sep 28, 2017 at 1:03 PM
    Last edited: Sep 28, 2017
  4. slip

    slip Type 1 · Well-Known Member

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    Maybe it would if you were on a keto diet? At 41u of levemir a day split I'm obviously way off the mark too! :D
     
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  5. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Many hold him in high regard, me personally - not so much.

    What were his exact words?
     
  6. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    The PDF of his book is on my work pc. It for a walk at the mo. I'll take a look when I get back
     
  7. Juicyj

    Juicyj Type 1 · Moderator
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    Did he mention splitting doses based on this advice ?

    Unless you are very young child I cannot see how this advice is plausible to all t1 adults..
     
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  8. tim2000s

    tim2000s Type 1 · Expert
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    Even on a keto diet my basal doesn't drop below about 20u a day. It's essentially what you need to counter any glucose production from your liver, so you have to go with what you measure. Technically, given that studies in the early 80s showed that non-T1 adults need and produce about 40u per day, that does seem like a rather abitrary figure.
     
  9. slip

    slip Type 1 · Well-Known Member

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    Tim are you then saying I'm normal ;)
     
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  10. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    In his book on page 106:

    "I have a very obese patient who requires 27 units of long-acting insulin
    at bedtime. He's so insulin-resistant that there's no way to keep his blood sugar under control without this massive dose. In order to ameliorate the unpredictability of large doses, he splits his bedtime insulin into four small shots given into four separate sites using the same disposable syringe.
    As a rule, I recommend that a single insulin injection never exceed 7 units for adults and proportionally less for children
    , depending on their weight."

    The ultimate goal of this book is to manage blood sugars. This is done via a low-carb diet. Perhaps if you are doing low carb high fat or a keto diet then you might be able to lower down to 7 units per day. I'm currently trying to achieve a state of ketosis, and though this is a challenge I still cannot go down to 7 units. I'm going to go back to 32 units and if I'm starting to get close to daytime hypos then I will lower my basal doses.
     
  11. slip

    slip Type 1 · Well-Known Member

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    Ah he's not saying 7u per day but 7u per injection
     
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  12. Deleted Account

    Deleted Account · Guest

    That is how I read it.
    However, I do not know why there is a problem with injecting more basal.
    If the basal lasts 24 hours and the requirements are stable throughout that time, I see no reason for splitting the dose.

    Some basal does not last this long and some people experience higher needs at different times of the day. Hence, some people split their dose but splitting it four times seems excessive .. and if these four times are equally spaced, you could not sleep for more than 6 hours as you will need a basal dose during the night.
     
  13. GrantGam

    GrantGam Type 1 · Well-Known Member

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    @slip is right. I've heard members here mention that they've been told to split doses larger than 8u, rather than give it in one go.
     
  14. GrantGam

    GrantGam Type 1 · Well-Known Member

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    They're still taken at the same time @helensaramay, just divided into separate injections.

    I never do it with mine, but some HCP's advise on dividing up larger doses into separate injections.
     
  15. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    Oh flip. You're right. It's per injection, not total for the day!! How could I have read this wrongly?!

    Hey ho, it makes total sense now. Thanks you guys. I'll be keeping my 32u dose, though it never seemed to be an issue taking it all before bed.

    Still, on my original question, what do you think is best. More Basal or more Bolus?
     
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  16. HeartlessHaxisal

    HeartlessHaxisal Type 1 · Member

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    It sounds like a cop out answer, but if you know what works for your body, then stick to it. You know yourself more than any doctor.

    I believe my own basal is around 14 units? I just adjust up or down to accommodate what my body needs, I don't care what this doctor says.

    It's ridiculous and possibly harmful advice to say you should only use 7 units of insulin if you require more, it could lead to spikes in your bloods and therefore reduce your control over them.

    If it means per injection, I guess I can see the logic behind it, but as long as you regularly rotate your injection/cannula sites so you don't become insulin resistant, I don't see the issue.
     
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  17. Lord Midas

    Lord Midas Type 1 · Well-Known Member

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    Yes, I did try out 7 units to see if I was indeed taking too much insulin. Nope. 7u was far too low. To be fair I should have started reducing my basal in much smaller doses rather than go full on down to 7u. Still, I learned a valuable lesson... via high bs for a few weeks (and taking more bolus as a result).
     
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  18. ickihun

    ickihun Type 2 · Master

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    I know I'm type2 but I'm on 63units of toujeo300 basal. I was on 72 but have been able to reduce it slowly and in keeping with weight loss.
    I'd question that 7units as a small woman and a muscular man would need different amounts of insulin. Surely!
     
  19. tim2000s

    tim2000s Type 1 · Expert
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    That's exactly what the statement is. Once you get above 7u for a dose, there's a belief that you get slower absorption due to the relative surface area to volume of insulin. At doses of 7u or smaller, you have multiple spheres of insulin and therefore absorb it all much faster. The same would be true for a large bolus. However there has since been evidence that suggests that insulin doesn't diffuse from the tip of the needle in a sphere, but in fact spreads along the collagen matrix parallel to the skin until you reach a certain volume (reckoned to be 100 microlitres) when you also get a perpendicular spread https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3692237/

    This is somewhat backed up in some experimental work done and patents on "Sprinkler Cannulas" for pumps, where the needle had six separate holes. Fast acting insulin absorption was significantly better.

    A patent: https://encrypted.google.com/patents/US20130245555?cl=ru

    Some research that demonstrates the benefits: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1246546/pdf/bmjcred00022-0009.pdf

    What do I take from this? All Insulin needles need redesigning, and you might see significantly faster acting Novorapid, Humalog and Apidra if they were available.
     
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  20. Kristin251

    Kristin251 LADA · Expert

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    I use my basal to keep me steady through the night and bolus during the day. My basal is long gone by morning.
    If I took enough basal to get me through the day I'd hypo during the night.
     
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