Why would a type2 need soooo much basal but on 20unjts of novarapid only per meal?

[ickihun]

Im on 78units of toujeo300 basal and 60-80units 60-80units of bolus.

Is my high basal units high because of
my excessive 8st overweight as well as severe insulin resistance?
I'lI be intetesed to see how much I can reduce it too. When losing weight.

Ive increased basal lately not reduced it. I was getting too many higher bgs. I've added a fraction of weight as a result.
Was hoping to reduce iti

Any ideas on how?

 

[phdiabetic]

How many carbs do you eat per meal? To be honest, 20u is a LOT for a mealtime bolus (I never have more than 10, and usually quite a bit less).

As you said, weight gain can lead to insulin resistance so losing some weight will most likely help cut your units down. Also exercising can make you more sensitive to insulin and reduce both your bolus and basal doses around the time you exercise.

 

[paulus1]

no easy choice its either low carbing or v low cal diets plus metformin just pumping more and more insulin is just going to make the resistance worse. causing weight gain causing more residence needing more insulin and the cycle repeats. by reducing the carb load you need to reduce your insulin dose you lose weight the residence reduces and the cycle goes the other way. whether you can become insulin free is possible but not certain.. your totally in charge dont allow your condition to rule you.

 

[SimonCrox]

Interesting question. Being overweight as you say contributes to insulin resistance as do other things such as family history and lack of exercise and some drugs. The insulin resistance makes the insulin less effective at switching off the production of glucose overnight from the liver, hence the glucose levels rise overnight and one addresses this with the basal insulin.
And as folk above state, the risk is that the insulin helps put on weight and hence needs more insulin. Metformin reduces the weight gain a bit, but it is often still a problem in many patients. One can mix a GLP-1 RA such as liraglutide with the insulin which helps to reduce weight; Novo sell big dose liraglutide as a weight loss injection for anyone very overweight, but the data that I saw suggested that in diabetic folk, the weight loss was similar on diabetic doses (1.2-1.8 mg per day) and on weight loss doses (3 mg / day).
But none of thsi works without diet, and I hope that this is going OK
Proportionally, folks with Type 1 often need a similar amount of basal and bolus, so if you are on 68 toujeo and 70 units bolus with each meal, your basal dose is not particularly high. Your doses are on the large side, but I have seen many higher. The real question is "Is it doing the trick?"
best wishes

 

[catapillar]

@ickihun Why is this discussion in the type 1 sub forum, when it's obviously a discussion about management of type 2 with insulin? Wouldn't you be better off asking in the type 2 on insulin forum?

I don't know if as a type 2 on a basal bolus regieme your insulin is designed to do the same thing as for a type 1 on a basal bolus regiem. I think I recall you mentioning that you don't carb count for you bolus doses, so obviously that's different to type 1 management. I'm not sure if your basal dose is designed to keep you flat-ish when not eating or bolusing, if so you might want to do some basal testing to see if you are on the right dose - https://mysugr.com/basal-rate-testing/ , or if it's designed to mop up some of the food that isn't carb counted, in which case basal testing wouldn't be appropriate.

But your doses look about 50/50 split between basal and bolus, which is what they are supposed to be.

 

[ickihun]

no easy choice its either low carbing or v low cal diets plus metformin just pumping more and more insulin is just going to make the resistance worse. causing weight gain causing more residence needing more insulin and the cycle repeats. by reducing the carb load you need to reduce your insulin dose you lose weight the residence reduces and the cycle goes the other way. whether you can become insulin free is possible but not certain.. your totally in charge dont allow your condition to rule you.

When I was on mixed insulin I was able to come off insulin for nearly 1 day (due to basal and medium acting insulin it administered). Then I crashed into keto acidosis territory. So increased til I got bgs down again and specialist changed me to individual insulins.
Very low carbing.
However this also came with severe palpatations and chest pains so had to have 6mths of waiting for 3 investigations.
I wont be doing ultra low carb again.

I just wish i could exercise more. The bulging disc or whatever it maybe (mooted gallbladder or organ infection or something.. Awaiting abdominal scan). Severe pain stops me walking even with a crutch (for 2yrs now).
Tramadol worked for a year but then stopped working. Codeine a waste of time and gave me constipation which exacerbated the whole problem. Everywhere.

Ive been prescribed metformin throughout.
Metformin still on maximum dose.

I couldnt reduce basal in the summer time either. When i was most active on tramadol.
Strangely everytime I try to reduce I end up needing more? Strange. Don't you think? Maybe making my IR worse?

 

[ickihun]

@ickihun Why is this discussion in the type 1 sub forum, when it's obviously a discussion about management of type 2 with insulin? Wouldn't you be better off asking in the type 2 on insulin forum?

I don't know if as a type 2 on a basal bolus regieme your insulin is designed to do the same thing as for a type 1 on a basal bolus regiem. I think I recall you mentioning that you don't carb count for you bolus doses, so obviously that's different to type 1 management. I'm not sure if your basal dose is designed to keep you flat-ish when not eating or bolusing, if so you might want to do some basal testing to see if you are on the right dose - https://mysugr.com/basal-rate-testing/ , or if it's designed to mop up some of the food that isn't carb counted, in which case basal testing wouldn't be appropriate.

But your doses look about 50/50 split between basal and bolus, which is what they are supposed to be.

Thanks catapiller. i can ask to be moved but not much experience in that section at times.
I know many type1s are experts with insulin management. I just need some ideas.
A fresh opinion always helps!

There's nothing about insulin you guys don't know. Luckily for me.

 

[slip]

so if you are on 68 toujeo and 70 units bolus with each meal, your basal dose is not particularly high.

Simon you missed the 300 bit regarding the basal dose, the OP is on 68u of 300 strength basal, so ~3 times as much as the average bolus (which although ickihun hasn't stated should be assumed to be 100 strength).

 

[ickihun]

@ickihun Why is this discussion in the type 1 sub forum, when it's obviously a discussion about management of type 2 with insulin? Wouldn't you be better off asking in the type 2 on insulin forum?

I don't know if as a type 2 on a basal bolus regieme your insulin is designed to do the same thing as for a type 1 on a basal bolus regiem. I think I recall you mentioning that you don't carb count for you bolus doses, so obviously that's different to type 1 management. I'm not sure if your basal dose is designed to keep you flat-ish when not eating or bolusing, if so you might want to do some basal testing to see if you are on the right dose - https://mysugr.com/basal-rate-testing/ , or if it's designed to mop up some of the food that isn't carb counted, in which case basal testing wouldn't be appropriate.

But your doses look about 50/50 split between basal and bolus, which is what they are supposed to be.

Basal testing done and yes flat on not eating so i can tick that box. Even A&E impressed.
I just want to reduce my 78 triple strength basal units.... some how.
Is exercise and weight loss the only influence on type1 basal reduction?
Or maybe i should be asking what causes increases in type1 basal need?

 

[ickihun]

Simon you missed the 300 bit regarding the basal dose, the OP is on 68u of 300 strength basal, so ~3 times as much as the average bolus (which although ickihun hasn't stated should be assumed to be 100 strength).

Thanks @slip Yes I'm on 78units of triple strength basal.

 

[SimonCrox]

Simon you missed the 300 bit regarding the basal dose, the OP is on 68u of 300 strength basal, so ~3 times as much as the average bolus (which although ickihun hasn't stated should be assumed to be 100 strength).

Are you sure? Humulin R U500 soluble comes in vials (pen coming soon, I think) so as you say, with this insulin on standard U100 syringes, the dose is 5 times that on the syringe, but I thought that U300 toujeo, U200 degludec and U200 humalog pens had doses on dial that corresponded to the dose given. Thanks for raising this - I will find out, unless other folk here have the answer (probably do).
best wishes

 

[JoeT1]

Basal testing done and yes flat on not eating so i can tick that box. Even A&E impressed.
I just want to reduce my 78 triple strength basal units.... some how.
Is exercise and weight loss the only influence on type1 basal reduction?
Or maybe i should be asking what causes increases in type1 basal need?

I found that my Basal needs dropped a whole pile with more exercise and losing a little weight, more so though down to eating Keto or Low Carb as my fast acting needs dropped dramatically and along with that my Basal also dropped.

I can't give any advice though as I am no expert when it comes to Type 2 and Basal/Bolus with that type.

 

[Deleted Account]

I know many type1s are experts with insulin management. I just need some ideas.
A fresh opinion always helps!

There's nothing about insulin you guys don't know. Luckily for me.

We are experts with insulin management for type 1.
We have experience of bruising and leakage from injecting. We have experience of broken pens and twisted needles.
We know the doses we have ourselves. I don't know what doses other people with type 1 take and have no idea how much that would increase with insulin resistance as you have with type 2.

In other words, people with type 1 are not experts in treatment (with insulin or anything else) for people with type 2.

 

[River83]

Very low carbing.
However this also came with severe palpatations and chest pains so had to have 6mths of waiting for 3 investigations.
I wont be doing ultra low carb again.

Very low carb or ketogenic diets can cause palpitations, however they are usually due to an electrolyte imbalance rather than anything else. The body retains much less salt when carbs are removed so you need to ensure that you are including additional salt in your low carb or keto diet.

Reducing carbs and increasing exercise will reduce your weight and will make you less insulin resistant.

 

[TheBigNewt]

Are you sure? Humulin R U500 soluble comes in vials (pen coming soon, I think) so as you say, with this insulin on standard U100 syringes, the dose is 5 times that on the syringe, but I thought that U300 toujeo, U200 degludec and U200 humalog pens had doses on dial that corresponded to the dose given. Thanks for raising this - I will find out, unless other folk here have the answer (probably do).
best wishes

U500 means there are 500 units of insulin per 1cc of liquid. They make it because of people like the OP, largely Type 2's who need much more insulin than we usually do. I see people at the VA who take 200 units of Lantus/day and up to 100 units of Novolorapid per meal. Too bad we don't supply the more concentrated versions of insulin.

 

[Daibell]

One of the problems with diabetes treatment for T2 is that GPs will sometimes keep adding tablets and then insulin when in fact the patient is sometimes overweight, with high insulin resistance and getting the pancreas to produce more insulin or injecting it can be counter-productive as there may already be too much insulin. The best first move if overweight is to get the carbs down and see what that does to both weight and blood sugar. This can lead to the meds being reduced. Various posts on this forum over years testify to that. It may not work for all T2s but low-carbing is always worth a try. BTW a c-peptide test will show whether your natural insulin level is too high.

 

[Bluetit1802]

I tend to agree with @Daibell about asking for a c-peptide test.

If your natural insulin is alive and well it shouldn't need supplementing to the degree it is being.

 

[paulus1]

you dont need to be ultra low start say at 150 and see what your body can cope with. ever increasing insulin dose sis not something you want to be doing. have you considered surgery but that does have risks.

 

[Seacrow]

It's nice to find others with the same problems, so thanks ickihun.

I'm currently on 180u basal (Humulin r500 via pump) and maybe 500u bolus. My latest c-peptide test showed my pancreas has totally given up, so all the drugs like metformin, glic---, or glip--- (can't remember names) do nothing other than confuse my endocrine system.

The only things I've found that reduced my basal are going on a pump (from about 400u down to 180u), and very cold weather. My consultant said that while background insulin are in theory completely flat in their activity profile it can vary enormously from person to person. The higher the number of basal injections, the closer to a flat profile, and your body uses it more efficiently. (I tried lantus, and it was nowhere near flat). Also, a large insulin dose in one injection site changes the way the insulin diffuses into the body - which is why higher concentration insulins have a later and lower peak activity.

Not too sure about why cold weather makes my basal needs decrease - I would have thought I'd be using more energy to stay warm.

SimonCrox, in the UK Humulin R500 was available in 20ml vials, which meant x5 if using a 'normal' syringe. Now Lilly are ceasing production, and making pre filled pens only. These will have the actual number of insulin units on their scale. I don't know about the other concentrations, it (should) take a consultant to prescribe them (since they are named patient only drugs). My hospital does the two concentrations, and thinks that is dangerous enough with the risk of confusion.

 

[ickihun]

One of the problems with diabetes treatment for T2 is that GPs will sometimes keep adding tablets and then insulin when in fact the patient is sometimes overweight, with high insulin resistance and getting the pancreas to produce more insulin or injecting it can be counter-productive as there may already be too much insulin. The best first move if overweight is to get the carbs down and see what that does to both weight and blood sugar. This can lead to the meds being reduced. Various posts on this forum over years testify to that. It may not work for all T2s but low-carbing is always worth a try. BTW a c-peptide test will show whether your natural insulin level is too high.

My endo said I'm severely insulin resistant and after bariatric surgery I will most likely be on basal only and metformin. So hoping for no novarapid and less toujeo300 units. With approx 8-9st loss over 8-12mths. My calorie intake will be nil for a few days then approx. 200cals for 2wks then increased.

Im just trying to reduce my insulin as much as possible now. Pre-op.
A good start always helps.

I guess I'm hoping to get actively mobile again but currently with muscle spasms effecting my movement and walking. Pain is off and on but fatigue due to exhaustion at times. Walking when I can, in pain is the best i can handle. Investigation into my gallbladder and ovarian health is on the way too. (ultrascan).
Weightloss has stalled.
I'll keep at it.
Thank you. Everyone.
I appreciate your input.