any type ones who take only bolus (no basel)?

[codlost]

hello 🙂
I have been diabetic since June 2017 and have been taking novo rapid and toujeo since then.
I have been slowly reducing my basal (toujeo) for months now as i keep going low during the night (have to have snacks without insulin during the night to not go low) , and had gotten it down to 4units from 12units. during this time my insulin carbs ratio for bolus has stayed the same .

I forgot to take my basal on Sunday, and noticed no different to my bloods on Monday so have not taken and basal since Saturday. i am now not going low during the night , but my bloods still drop for maybe 6/7 when going to sleep to 4.5 in the morning (nice slow drop). I am wearing a freestyle libre at the moment and my bloods seem stabler with out taking the basal. so was wondering if anyone is on only bolus insulin ?

I also have cirrhosis of the liver , so maybe that is effecting my livers ability to store and release glucose ? :s

 

[codlost]

forgot to add i take about 40 -50 units of novo rapid per day / one unit per 3 carbs (been told i have some level of insulin resistance as a result of my liver problems and being on steroids but also probably still producing some of my own insluin/ in honeymoon period) , this ratio has stayed the same and keeps me in range even now with no basal.

 

[everydayupsanddowns]

Our very own admin @Northerner has been taking only basal for a few years now, though he recognises that it’s quite unusual.

Out of interest, have you tried skipping meals to fasting test your insulin needs through the day? It is possible that the 5-ish hour profile of rapid insulin spaced apart for three meals, along with your high-ish ratio might be covering a low basal requirement (that then drops even lower at night).

At the end of the day it’s all a bit academic though if you’ve found a system that works well for you 🙂

 

[codlost]

has he any liver or other health conditions that might be a reason for not needing basel ?

 

[codlost]

ya kind of (not a full fast but not eating anything i need insulin for). my normal working day i have breakfast at 8 / 8.30 which i take insulin with normally 10 units , then at 11 i have about half a cup of tea with a drop of milk in it , and at 1 i have another half cup of tea with a little milk and a low crab yogurt (5,2 carbs) then at around 4.30/5 i have dinner around 20 units of insulin, and then at 9pm i have a snack, 10 units of insulin.

so from around 12.00 -5.00 i would have no insulin working and my bloods would go up and down but stay in the 5-8 range.
and from 1am - 7 am i would also have no insulin working and my bloods would slowly drop from 6 - 4.something

 

[codlost]

Also another thing that seems a little strange is i can eat high fat food and not have a delayed effect or have to split doses. the weekend before last i had a chipper fish and chips 🙂 (i would have been on basal then tough)
i was 6.3 at 14.38 when i took full dose of insulin and eat.
6.9 at 15.15
7.4 at 15.47
5.9 at 16.21
5.3 at 17.35
5.9 at 19.08
5.7 at 20.06
5.2 at 21.14
then i had normal night snack and insluin dose and everything was as it is on a usual night.

the only reason i can come up with is that their could be something up with how my liver processes and stores food. I know my liver function is bad (im currently being asses for a transplant) but never really considered what this meant from a food point until recently.

 

[trophywench]

It sounds to me like that's a possibility - but I think you'd have to discuss it with your liver person (err, hepatolgist??) co the likes of me doesn't know the full workings of our liver so I dunno whether it's even likely or completely impossible.

Like someone on another diabetes forum asked today about teeth - is there a Haynes Manual for livers? LOL

 

[Northerner]

hello 🙂
I have been diabetic since June 2017 and have been taking novo rapid and toujeo since then.
I have been slowly reducing my basal (toujeo) for months now as i keep going low during the night (have to have snacks without insulin during the night to not go low) , and had gotten it down to 4units from 12units. during this time my insulin carbs ratio for bolus has stayed the same .

I forgot to take my basal on Sunday, and noticed no different to my bloods on Monday so have not taken and basal since Saturday. i am now not going low during the night , but my bloods still drop for maybe 6/7 when going to sleep to 4.5 in the morning (nice slow drop). I am wearing a freestyle libre at the moment and my bloods seem stabler with out taking the basal. so was wondering if anyone is on only bolus insulin ?

I also have cirrhosis of the liver , so maybe that is effecting my livers ability to store and release glucose ? :s

Hi @codlost, welcome to the forum 🙂 As @everydayupsanddowns says, I no longer need basal insulin. When I was diagnosed I was put on 20 units of lantus and 45 units of novorapid per day. After 12-18 months I had to start reducing lantus in order to avoid night hypos. Over a longer period of time to you, the lantus eventually reduced down to 2 units, then I decided to try without - no difference! This was reached at about 4 years after diagnosis. At that time I told my consultant about it and he said I would probably start needing it again within a month or two - that was 6 years ago. My novorapid requirements have also reduced, although I do still need it for any carbs. I have had the occasional 'day without diabetes' when I have only eaten non-carb meals and my levels are around the 7-9 mmol/l mark without any insulin.

I don't, however, have any problems with my liver, other than an elevated bilorubin level, which my GP believes to be Gilbert's Syndrome.

I have encountered a handful of people here on the forum in a similar position over the past 10 years or so, so it's rare, but not just me (or you! 🙂 ).

Let your DSN or Consultant know, and if they are sceptical then let them know about me. It seems that my pancreas recovered to some extent gradually and now is able to produce sufficient insulin to cover my basal needs. I have also used a Libre and it shows my levels as perfectly flat in the 4s and 5s throughout the night. Levels start to rise as soon as I raise my head from the pillow, however, I suspect that my liver is particularly 'quiet' through the night, and then during the day I am actually covering my basal needs with my novorapid, with injections for meals 5 hours apart.

In fact, I believe there are quite a few people on pumps who have periods of very low basal requirements, or even zero, especially during the night - as they are able to adjust basal insulin on an hourly basis they may not realise that, actually, they are in the same boat as me 🙂

I actually think it helps me keep my levels under good control - my pancreas is providing a little bit of support whereas for most people no basal means an ever-increasing BG level e.g. when a pump cannula fails.

My advice would be to simply keep monitoring - the need for basal may re-emerge or it may not. Try the occasional non-carb day and monitor your levels closely. I remember feeling that a weight had been lifted from me when I no longer needed to worry about night hypos and I have always felt very fortunate in that respect, given the problems so many people have to cope with.

 

[khskel]

I had several months when I was on no basal, confirmed by basal testing. I am back on it now but the amounts required do still vary from time to time.

 

[everydayupsanddowns]

I am one of the PWD reps on a panel of healthcare professionals trying to improve care for people with T1D and as part of that I was able to attend the Diabetes UK Professional Conference for a day. While there I saw a fascinating presentation during which it was made clear that the primary function of insulin is to manage glucagon output from the liver rather than dealing with carbs with food. This seems completely counter-intuitive, but is something that can be measured by identifying and tracking what objected insulin is up to. I wish my knowledge of physiology was good enough to have properly understood it - but I certainly found it interesting!

 

[codlost]

thanks for all your replies 🙂
Northerner - i have (very) high bilirubin levels normally around 78mg/dl. And i think my honeymoon phase might be similar to your somewhat recovered pancreas.

To be honest i have not told my drs yet, i know i should but i want to be more sure first. so am going to watch and monitor super carefully for a week before i ring my diabetic nurse. my endocrinologist views my diabetes very separate to my other health conditions, so i actually think my hepatologist might be better able to advise me.

Im not meant to go long periods with out carbs as i have osteopaenia, (something to do with if i dont eat , my liver tries to get get energy from my bones instead). I used to eat (am supposed too) have 6 small meals/snackes a day but since becoming diabetic i have been only having 3 meals as that was what was advised by my diabetic dietitian, and i cant figure out how to have 2 lots of insulin over lapping, and if i eat anything more the 8 crabs in need insulin for it.

I am happy being on bogus only and think ill might have better control with it. The only thing that worries me is if i can still have a hypo if i went to long with out food and perhaps my liver might not be able to do a liver dump ? what happens to you if you go a long period with out food ?
at the moment i have a little snack at around midnight to raise my blood sugars to 7/8 , the last bogus would have been at 9 so should be almost stopped (i was told my novorapid works for 4 hours but ye say it might be 5 hours ? when i wake at 7.30 my bloods are in the low 4's.

 

[Northerner]

The thing with using a bolus insulin like novorapid is that you only inject it if you intend to eat carbs - if you don't eat, you don't inject and you therefore shouldn't have hypos 🙂 Novorapid can vary in duration, so it can affect people for different lengths of time, between 3-5 hours. Also, it can last longer or shorter depending on where you inject, as absorption can vary according to injection site - for me it absorbs much more quickly from my abdomen than my buttocks.

I'm afraid I don't know enough about your other conditions to know how things might work for you. We are extremely complex beings and all unique in many ways, so this is why there are no hard and fast rules for diabetes, you have to learn through experience how things work for you. As long as you are always prepeared with meter and jelly babies to hand you shouldn't need to worry, things usually become more instinctive in time 🙂

 

[trophywench]

Osteopenia is an overall term for 'thinning' of bones, not what actually caused it - so eg shedloads of post menopausal women have it naturally as they age anyway and it's a completely natural product of aging.

With regard to insulin, since all of the human body needs insulin to get glucose into the cells to fuel activity, 24 hours of every day. So if it isn't getting any, then it will die because nothing at all can function.

The classic Type 1 'honeymoon period' is only present when the pancreas is still producing some 'natural' insulin itself, hence when it ends cos the insulin producing cells within the pancreas have all finally popped their clogs, the person needs MORE exogenous insulin than before, not less.

I do think you and others who've said this are correct in that you really are going to have to ask your clinicians - not ordinary diabetics about this, because none of us is you with the same collection of other things you have going on.

 

[codlost]

yes i know what Osteopenia is , but mine is caused as a result of my liver damage not my age (im 27).

I am having insulin , just not basal and i AM in my honeymoon period so getting natural insulin from that as well.

I am going to speak to my drs, but it will be months before i see them. And i will ring a tell my diabetic nurse but wanted to see if it was the case that their were other type one diabetics who dont take basal and i think i need to have a better understanding of whats going on my self before i speak to her , like this could be perhaps a fluke few days and tomorrow my blood glucose levels might start to rise. I believe if i was to have rang her when i first decided no try not taking basal she would probably have told me i need basal and to take it where as now i can say their are others who don't take it and give her examples of my bg numbers over a periods of days. I dont think im causing any harm to myself as im watch motoring everything carefully and im no longer going low during the night.

 

[Northerner]

yes i know what Osteopenia is , but mine is caused as a result of my liver damage not my age (im 27).

I am having insulin , just not basal and i AM in my honeymoon period so getting natural insulin from that as well.

I am going to speak to my drs, but it will be months before i see them. And i will ring a tell my diabetic nurse but wanted to see if it was the case that their were other type one diabetics who dont take basal and i think i need to have a better understanding of whats going on my self before i speak to her , like this could be perhaps a fluke few days and tomorrow my blood glucose levels might start to rise. I believe if i was to have rang her when i first decided no try not taking basal she would probably have told me i need basal and to take it where as now i can say their are others who don't take it and give her examples of my bg numbers over a periods of days. I dont think im causing any harm to myself as im watch motoring everything carefully and im no longer going low during the night.

Yes, the main thing is to keep monitoring, especially to compare your before bed and waking numbers to see how your body has coped overnight. As long as your levels are behaving then all is good - what you don't want to do is inject unnecessary basal insulin and then get lows in the night. It could be that your liver slows its output of glucose considerably overnight, or at least part of it. As I mentioned earlier, many people on pumps find that there is a period of an hour or two when they don't need basal - injecting basal gives no fine control over this period. I'd give it a week and then call your DSN 🙂