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BASAL/ BOLUS THERAPY

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billyblue

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Relationship to Diabetes
Type 1.5 LADA
Hello Everyone,

Anyone in here red Dr. Richard K. Bernstein book, "Diabetes solution" and tried splitting the Basal insulin as recommended in the book? half at bed and half 2 hours before waking up?

what is your way of injecting the basal?
I am on bolus after a meal not before since my body absorbing insulin very fast and not enough left to cover the after-meal sugar effect, anyone in here tried this way?

Thank you all
 
Hi 🙂

I haven't read the book but there are a few that split their basal dose, many find that it isn't as simple as a split half and half and often require a larger dose for one 12 hour period and a lower dose for the other 12 hour period, it also depends what basal insulin you are on as not every basal has the same profile and splitting wouldn't be advisable, such as Tresiba that I'm on, it can last 40+ hours in the system so splitting wouldn't be beneficial

@Robin splits her basal dose but I cant think of others at the moment (so Robin I do apologise)
zz
 
No worries, @Kaylz. Yes, I split my Levemir, because I need quite small doses and it doesn’t last the full 24 hours, it also means I can split it to give myself less during the night when I tend to go low. I take mine at bedtime, and as soon as I wake up, so the timing is not a completely even split either. (when you say you take yours 2hrs before waking up, do you mean 2hrs after waking? Or do you wake up, take it, and go back to sleep?)
 
Robin said:
No worries, @Kaylz. Yes, I split my Levemir, because I need quite small doses and it doesn’t last the full 24 hours, it also means I can split it to give myself less during the night when I tend to go low. I take mine at bedtime, and as soon as I wake up, so the timing is not a completely even split either. (when you say you take yours 2hrs before waking up, do you mean 2hrs after waking? Or do you wake up, take it, and go back to sleep?)
Click to expand...

@Robin yes 2 hours before waking up, wake up take the dose and sleep again.
as per Dr. Richard K. Bernstein, this is the best way to keep normal blood sugar, for him normal blood sugar is 83 mg/ dl (4.6 mmol)
I am on tresiba at the moment 8 units bed time only and its keeping my reading around 100mg all day but still my fasting is not going under 115 mg so probably splitting might help probably but for sure the dose will be increased to 10 units (split in 5units).

regards
 
As Kaylz says in her post, splitting Tresiba isn't really an option, as the doses last for around two days, and by taking it once a day, you are constantly topping up your system, so it has a really flat profile, and splitting it shouldn’t really make any difference to that. The problem a lot of people have, is that the the liver starts increasing its output of glucose around 4am, gearing up ready for the day ahead, and this can cause a small rise in your blood glucose in the morning.
We use different measurement in the UK, so your 100mg/dl equates to our 5.6 mmol/l, and 115 equates to around 6.4. I’d be very happy with those readings. Trying to keep it in the 80s, or for us, in the 4s, runs the risk of frequent hypos, and frequent hypos mean you run the risk of losing hypo awareness.
 
That level isn't really normal to run at consistently and as an insulin user being there all the time comes with risks of losing hypo awareness, I talk from personal experience there, a waking off 115 is perfectly acceptable (our 6.4) and isn't anything to be concerned about, Tresiba doesn't benefit from being split due to its extra long profile and that it doesn't really have a peak time, I've been on it 3 years so know quite a bit about how Tresiba works whereas I believe you are new to it xx
 
@Robin & @Kaylz very helpful, much appreciated
Yes i am new to Tresiba, that's my second week switched from levemir

@Kaylz, " The problem a lot of people have, is that the the liver starts increasing its output of glucose around 4am, gearing up ready for the day ahead, and this can cause a small rise in your blood glucose in the morning." How can we fix this?

thank you
 
@billyblue what are your levels generally like when you wake? anything up to 126 for you wouldn't require anything to be done to be honest, yes its not ideal but its still within range, if you rise badly then you may need to control it with fast acting insulin as Tresiba really isn't as flexible as you sound like you want it to be, 2 weeks in isn't that long to be fair and many find the adjustment period takes a bit longer after switching from another insulin

Are you actually having a rise or is that a quote from the book?
xx
 
Kaylz said:
@billyblue

Are you actually having a rise or is that a quote from the book?
xx
Click to expand...
That’s a quote from my post, Kaylz, as billyblue had said his fasting test wasn’t going below 115, whereas his daytime average was 100, I made an assumption that it was a dawn rise.
 
check this out, very interesting to watch it all and many more for Dr. Richard K. Bernstein but move the video to 40:35 minute as might have some good answers


 
Sorry many may believe in his beliefs and views but I ain't one of them, some things he believes in just isn't healthy so I'm sorry but I wont be watching xx
 
billy - you want to know how to FIX something that the human body only does because whoever created the human body designed the liver to do exactly what was described?

Might just as well try to stop breathing and see how much good that does you! LOL
 
Incidentally, did you know that things about diabetes are different for different people? eg we do not all need the same amount of insulin for either basal or bolus even if we all have the same level of activity and eat identical food at identical times - that is because no two human bodies or brains are identical, plus the fact that individual need for basal insulin changes almost hourly - hence why insulin pump manufacturers enable us to enter a different hourly rate every hour of the day and night.
 
I’d be a little cautious of aiming for a waking BG below 5mmol/L (90mg/dl)

The most recent NICE guideline examined evidence that showed an association with waking BG below 5 and increased risk of undetected non-symptomatic overnight hypoglycaemia, which can increase risk of developing Impaired Awareness of Hypoglycaemia.

Aiming for a waking BG between 5 and 7 is felt to be safer. Though that’s a laughably tiny target!
 
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@everydayupsanddowns thanks for this, very helpful.
I am trying to find a away to manage my dawn phenomenon by experimenting a bit with insulin timings and doses, do you know by any chance a good way to tackle the morning highs? bedtime readings are 5 to 5.5mmol but the morning readings are up to 7 to 7.8mmol,
I am aware that the numbers are not very high but it is always good to manage better
thank you
 
billyblue said:
@everydayupsanddowns thanks for this, very helpful.
I am trying to find a away to manage my dawn phenomenon by experimenting a bit with insulin timings and doses, do you know by any chance a good way to tackle the morning highs? bedtime readings are 5 to 5.5mmol but the morning readings are up to 7 to 7.8mmol,
I am aware that the numbers are not very high but it is always good to manage better
thank you
Click to expand...
are you using a CGM or FGM? are you testing your levels throughout the night? 3am etc? xx
 
Kaylz said:
are you using a CGM or FGM? are you testing your levels throughout the night? 3am etc? xx
Click to expand...
@Kaylz
I have a difficult lifestyle, i sleep at 2 am every night and awake at 8.30.
2 am readings (bedtime) 5 - 5.5 mmol and i am using FGM so the highs are happening within those 6 hours of sleep, but during the day it is always in 5mmol range not more
 
billyblue said:
@Kaylz
I have a difficult lifestyle, i sleep at 2 am every night and awake at 8.30.
2 am readings (bedtime) 5 - 5.5 mmol and i am using FGM so the highs are happening within those 6 hours of sleep, but during the day it is always in 5mmol range not more
Click to expand...
so from the FGM what time does your blood start rising? Tresiba split isn't going to change anything I'm afraid so it may be a case of you'll need to either increase your Tresiba dose slightly or wake up when you generally rise and combat it with a small dose of novorapid, what kind of device do you use to administer your insulin? pre-filled pens or a reusable pen? xx
 
Kaylz said:
so from the FGM what time does your blood start rising? Tresiba split isn't going to change anything I'm afraid so it may be a case of you'll need to either increase your Tresiba dose slightly or wake up when you generally rise and combat it with a small dose of novorapid, what kind of device do you use to administer your insulin? pre-filled pens or a reusable pen? xx
Click to expand...

Yesterday woke up at 4am and checked it out it was 5mmol and at 8.30 am was 6.7 so I guess it's happening between 4 to 8am
I'm using flex pen (pre filled)
Probably I need to increase the dose of tresiba from 8units to 10
 
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