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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. ickihun

    ickihun Type 2 · Master

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    When I inject is a certain area of tum I feel it trickling to a certain area. I guess to lowest point of gravity, near enough.
    When I inject standing up I get a bit leakage. Not when sedate. Anyone else noticed that?
    Some needles definitely cheaper than others given on my prescription over the years.
     
  2. ickihun

    ickihun Type 2 · Master

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    Me too. Too much basal gives me the somogyi effect through the night (only on toujeo300 thou). Just full blown hypos to a 1.7mmol/l once on humulin m3 mix.
     
  3. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Your asking a question that doesn't make any sense - nor does it have a sensible answer. Bolus dosing (amount and frequency) is relative to what you're eating.

    As I take 18u basal; and my ICR is 1:12; then depending whether I eat either side of 216g CHO will dictate whether my bolus is more or less than my basal. Is either one better, not at all. What is important is that my BG control is good.

    Basal rate testing will help you set your dose accurately. That part is important. How much bolus you're injecting to cover your carbs is irrelevant, unless it's compensating for a lack of basal. But, basal rate testing will help you avoid that.
     
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    #23 GrantGam, Sep 28, 2017 at 3:31 PM
    Last edited: Sep 28, 2017
  4. Fearless36

    Fearless36 · Well-Known Member

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  5. Deleted Account

    Deleted Account · Guest

    Thanks. Now I understand.
    I wonder how many people who split their doses changes needles between each injection. It would be a real faff doing 4 injections and changing the needle each time.
     
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  6. GrantGam

    GrantGam Type 1 · Well-Known Member

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    I probably made a poor job of explaining it...

    Very good point about the needle change, I wouldn't bother. But I also wouldn't bother with what Bernstein has said either. Over your lifetime, it would literally be thousands of extra injections if you followed that man's advice. I'll take my chances with possible site absorption "problems", over worn out injection sites from unnecessary dose splitting any day:)
     
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  7. Deleted Account

    Deleted Account · Guest

    I totally agree ... and that's before we start considering another load of injection sites to rotate.
     
  8. Struma

    Struma Type 2 · Well-Known Member

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    Personally, I think 'Think Like a Pancreas' by Gary Scheiner to be a slightly better written book. It has been popular on this site.
    This chap says 'It is commonly found that a 50:50 division in totals of basal and bolus proves the most effective.' This of course was written prior to the introduction of Toujoe or Tresiba. I have Lantus 56u/NovoRapid 60u. I quite like working along these lines.
     
    #28 Struma, Sep 29, 2017 at 6:05 PM
    Last edited: Sep 29, 2017
  9. EllsKBells

    EllsKBells Type 1 · Well-Known Member

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    @mahola as often your comment has given me a chuckle - I'm 55 kilos and 5 foot ten, which puts my BMI around 19. I now take 19 tresiba a day, but when I was on levemir, I was on 47 units split a day. Weight is NOT the only factor affecting insulin sensitivity, which, from what I've heard about Bernstein, is something his work does overlook slightly.

    @Struma mine also works out at about 50:50, on a decent day anyway. Before the switch to tresiba though, it was not even near that. It is really funny how different people get on with different insulins - I really struggled with levemir.

    @Lord Midas I don't think your question really has an answer. I suppose lifestyle also comes into it though - if your activity levels oscillate wildly from day to day, then perhaps that might affect it? I don't know :p
     
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  10. GrantGam

    GrantGam Type 1 · Well-Known Member

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    You could always try some jogging bottoms, a skirt - or even a pair of shorts - to see if that could bring your Tresiba dose down...

    :)
     
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  11. Scott-C

    Scott-C Type 1 · Well-Known Member

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    I've read a few online snippets of Dr Bernstein's books, but haven't read them in whole, so won't express a view till I've done so, but my general impression is that he's not the sort of guy who you'd want tagging along on Friday night out.

    "Come on, Richard, up for another pint here, mate?" "No, Scott, as I've explained in my book, you should eat no more than 6g of carbs at breakfast etc. etc." Yeah, well, it's been fun, see ya.

    His often quoted law of small numbers seems like utter cowardice to me. Here's what he says: http://www.diabetes-book.com/laws-small-numbers/

    He approaches this as if it were entirely an engineering problem, focusing on uncertainties in measurement. That's correct, there are deep uncertainties in T1, but just bailing out and saying, "limit carbs and it will solve everything" seems to ignore that with cgm, we can make adjustments on the fly, in the moment.

    All I know is that if I'd followed his advice, I would have spent my life saying, "ooh, sorry, I'm T1, I can't do that, Dr Bernstein says I can't.".

    I take my T1 seriously. I'm rarely over 8 or 9. There's the occasional visit to the low or mid teens when I make a mistake. We're not lab rats, but Bernstein seems to want to make us so. I've visited about 20 countries. I think my experience of them would have been impaired if I'd followed Bernstein's dictates.

    The irony here is that we all complain about non-T1s telling us, "you can't eat that", yet some seem happy enough with Bernstein saying the same thing.
     
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  12. therower

    therower Type 1 · Well-Known Member

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    @Scott-C . I've not read Bernstein and after reading your post I have no intention to.
    Can't think of anything worse than a perfect T1 diabetic.
    Great post.
     
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  13. GrantGam

    GrantGam Type 1 · Well-Known Member

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    Ach, and there was me thinking we had a good relationship @therower:)
     
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  14. therower

    therower Type 1 · Well-Known Member

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    @GrantGam . My most sincerest apologies.
    My intention to use the word "perfect" metaphorically seems to have caused you to question our friendship. This was never my intention.
    None of us are perfect....... I'm a miserable *****, 54 yr old, argumentative T1.
    And as perfect as you undoubtedly are......... I have to question your dietary choices sometimes, they are often far from perfect ;);););););).

    Good morning friend:) Hope all is well.
     
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  15. Kbarbaracollins_

    Kbarbaracollins_ Type 1 · Well-Known Member

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    I was advised by Dr Bernstein to split large injections to max 7 units per injection. But this doesn't mean you need to stagger them - just use injections in different sites. Apparently it helps to make absorption more uniform.
     
  16. Deleted Account

    Deleted Account · Guest

    Thanks for the clarification.
    I never split my injections and experienced no problems
    Out of interest do you change needles between each injection?
     
  17. JamesNhlman

    JamesNhlman Type 1 · Newbie

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    Yeah sounds like nonsense to be honest. I take 38 units of lantus before bed
     
  18. TheBigNewt

    TheBigNewt Type 1 · Well-Known Member

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    I take 25 Lantus first thing in the morning. I never took it at night. Works for me. I take about 20U Novorapid with meals, so it's pretty close to 50/50 basal/bolus. I use the pen needles until the pen runs out of insulin. I do put a new one on a new pen lol! AQ box lasts me a couple years.
     
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