Basal insulin only - is this OK?

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johntheterrier

Active Member
Relationship to Diabetes
Type 1
Hi all, I've recently started a very low carb diet (Keto), to try to improve my glucose readings, and have been staggered by the results. My "Time in target" has improved from about 55% to 98% and my average glucose reading has dropped from around 9.5 to 6.1. My sugars are unbelievably stable as well. What's really amazed me though is that I'm hardly using any of my bolus insulin (Fiasp), at all. Some days I am having no bolus whatsoever, where I was injecting say 6 or 7 units roughly per meal beforehand. I now occasionally take 1 unit only when I need a slight drop.

I take 22 units of basal (Tresiba) at night and this seems to be coping with everything I need.

Just wondering if anyone else is coping with basal insulin only? Feels really weird to me but it seems to be working perfectly?
 
How were you diagnosed with Diabetes, and what was your initial regime? It is possible that if T1 has been confirmed, you are in what is known as the honeymoon situation, where there are a few beta cells left in the pancreas that can just about cope with a last farewell. The answer to your question, is carry on with what you are doing. If the basal can control your BG without your Fiasp being used as a correcting agent, then at least you know the appropriate dose of your long acting insulin is perfect.

You will find that as time passes you will need more Fiasp, but don't worry asking if it's OK - it's whatever works, we are allll different. I bet you can't find any two T1s on the forum who take identical doses of their insulins.
 
Congratulations on the fabulous improvement on your time in range. How are you finding keto? Are you enjoying the menu?
I do low carb (about 50-70g carbs a day) but not keto as I am just not organized enough. I found that after a while I needed to start injecting for protein but I don't calculate it, I just adjust using corrections of Fiasp 2 hours after a meal. If I do lots of physical work I can get away with very little Fiasp but some days I might need 10 units. I was just musing the other day as to whether I could get away with just basal if I was really focused and increased my daytime basal to slightly more than I actually need to mop up the protein release.
We have some newly diagnosed members who are just on basal at the moment and managing fine with that for now but longer term I don't think there is anyone and a founder member of the forum who just uses bolus insulin and doesn't need basal.
For me I also take into consideration the use of resources and Fiasp tends to lose potency as it gets older, more so than NovoRapid I find, so my current situation means that I use up the Fiasp cartridge in about 30 days so there is no waste or loss of activity. Even managing without Fiasp most of the time you are still going to need the odd correction here and there so you might end up wasting a good portion of a cartridge at the end of 30 days or continue using it and find that you increasingly need to use more.
 
mikeyB said:
How were you diagnosed with Diabetes, and what was your initial regime? It is possible that if T1 has been confirmed, you are in what is known as the honeymoon situation, where there are a few beta cells left in the pancreas that can just about cope with a last farewell. The answer to your question, is carry on with what you are doing. If the basal can control your BG without your Fiasp being used as a correcting agent, then at least you know the appropriate dose of your long acting insulin is perfect.

You will find that as time passes you will need more Fiasp, but don't worry asking if it's OK - it's whatever works, we are allll different. I bet you can't find any two T1s on the forum who take identical doses of their insulins.
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Hi Mikey, I was diagnosed in 2001 so definitely not in the honeymoon period lol. Had a word with my DSN this afternoon, she confirmed absolutely fine to take basal insulin only if that's all I need. But yes you are right that we are all different and have different insulin needs.
 
rebrascora said:
Congratulations on the fabulous improvement on your time in range. How are you finding keto? Are you enjoying the menu?
I do low carb (about 50-70g carbs a day) but not keto as I am just not organized enough. I found that after a while I needed to start injecting for protein but I don't calculate it, I just adjust using corrections of Fiasp 2 hours after a meal. If I do lots of physical work I can get away with very little Fiasp but some days I might need 10 units. I was just musing the other day as to whether I could get away with just basal if I was really focused and increased my daytime basal to slightly more than I actually need to mop up the protein release.
We have some newly diagnosed members who are just on basal at the moment and managing fine with that for now but longer term I don't think there is anyone and a founder member of the forum who just uses bolus insulin and doesn't need basal.
For me I also take into consideration the use of resources and Fiasp tends to lose potency as it gets older, more so than NovoRapid I find, so my current situation means that I use up the Fiasp cartridge in about 30 days so there is no waste or loss of activity. Even managing without Fiasp most of the time you are still going to need the odd correction here and there so you might end up wasting a good portion of a cartridge at the end of 30 days or continue using it and find that you increasingly need to use more.
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Hi Barbara, thank you. I am finding Keto absolutely fine at the moment, fortunately I haven't got a really sweet tooth so I don't miss things like cakes or biscuits at all. I also do a lot of running, and am finding that because I have very little or no active bolus in my system when I go for a run, my blood sugar is more stable and I'm not having to keep scoffing jelly babies on the way round. I did expect a fair bit of improvement in my sugar levels with Keto, but am shocked at how stable my levels are now, my predicted Hba1c is coming down nicely. And it does feel really strange not bolusing before a meal and finding my readings have hardly moved afterwards. I'm definitely going to stick with the diet, have seen loads of easy Keto recipes online. I'm just having to plan and prepare a bit more. Wish I'd done it years ago.
 
Keto magic often comes as a suprise, but the glucose levels are proof enough.
The real challenge is pursuing keto over the long term.

The exercise also helps to round off the edges, and make the most of the basal only route.
 
johntheterrier said:
Hi all, I've recently started a very low carb diet (Keto), to try to improve my glucose readings, and have been staggered by the results. My "Time in target" has improved from about 55% to 98% and my average glucose reading has dropped from around 9.5 to 6.1. My sugars are unbelievably stable as well. What's really amazed me though is that I'm hardly using any of my bolus insulin (Fiasp), at all. Some days I am having no bolus whatsoever, where I was injecting say 6 or 7 units roughly per meal beforehand. I now occasionally take 1 unit only when I need a slight drop.

I take 22 units of basal (Tresiba) at night and this seems to be coping with everything I need.

Just wondering if anyone else is coping with basal insulin only? Feels really weird to me but it seems to be working perfectly?
Click to expand...

98% is impressive, get odd days at 100% but over week it averages around 80% TIR, sometimes bit less.

Don't know much about your keto diet, just find no matter what I eat have to bolus for it otherwise bg goes up.
 
nonethewiser said:
98% is impressive, get odd days at 100% but over week it averages around 80% TIR, sometimes bit less.

Don't know much about your keto diet, just find no matter what I eat have to bolus for it otherwise bg goes up.
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It's a very low carb diet, less than 20G per day. Loads of meat, fish, eggs, cheese, salad, green veg, a few fruits are allowed but i don't have them. Lots of easy interesting recipes, I have used a few from the Diet Doctor website. Am averaging about 2 x 1 unit shots of Fiasp per day. Eating carbs that would be an average of about 20 units per day over at lease 4 jabs, maybe more.
 
Benny G said:
Keto magic often comes as a suprise, but the glucose levels are proof enough.
The real challenge is pursuing keto over the long term.

The exercise also helps to round off the edges, and make the most of the basal only route.
Click to expand...
Yes you're right about pursuing Keto over the long term. If you were a sweet tooth person (which I'm not) who likes cakes, biscuits, puds etc as well as bread, pasta and beer, it would be pretty difficult. I don't think I'll have too much trouble sticking with it as I like most of the food on Keto and am not too bothered about carby/starchy food anyway. I actually feel much better on this diet so far. Time will tell. Thanks for your reply.
 
johntheterrier said:
It's a very low carb diet, less than 20G per day. Loads of meat, fish, eggs, cheese, salad, green veg, a few fruits are allowed but i don't have them. Lots of easy interesting recipes, I have used a few from the Diet Doctor website. Am averaging about 2 x 1 unit shots of Fiasp per day. Eating carbs that would be an average of about 20 units per day over at lease 4 jabs, maybe more.
Click to expand...

Get you so very low carb then.

See with those foods still need to bolus, did follow low carb diet for short while good few years ago & insulin requirements stayed same as before, only difference was had to do lots of corrections for slow release of energy from food so it wasn't doable long term as sites were already overused.

Stick with it fella, hopefully you can keep it going long term.
 
johntheterrier said:
Hi all, I've recently started a very low carb diet (Keto), to try to improve my glucose readings, and have been staggered by the results. My "Time in target" has improved from about 55% to 98% and my average glucose reading has dropped from around 9.5 to 6.1. My sugars are unbelievably stable as well. What's really amazed me though is that I'm hardly using any of my bolus insulin (Fiasp), at all. Some days I am having no bolus whatsoever, where I was injecting say 6 or 7 units roughly per meal beforehand. I now occasionally take 1 unit only when I need a slight drop.

I take 22 units of basal (Tresiba) at night and this seems to be coping with everything I need.

Just wondering if anyone else is coping with basal insulin only? Feels really weird to me but it seems to be working perfectly?
Click to expand...
Hi John,

I’m very interested in know how you’re doing this. I’m currently following Dr. Bernstein’s methods but with a carnivore diet and would love to try going “basal only” which I’ve heard it could be done. Dr. Ken D. Berry and Dr. Anthony Chaffee have both mentioned doing this for some of their T1 patients on their podcasts. Can I ask you more details? When do you inject your basal? How much protein and fat are you eating per meal? Thank you!
 
Elmas said:
Hi John,

I’m very interested in know how you’re doing this. I’m currently following Dr. Bernstein’s methods but with a carnivore diet and would love to try going “basal only” which I’ve heard it could be done. Dr. Ken D. Berry and Dr. Anthony Chaffee have both mentioned doing this for some of their T1 patients on their podcasts. Can I ask you more details? When do you inject your basal? How much protein and fat are you eating per meal? Thank you!
Click to expand...
I appreciate your question was directed towards John, but just wondering how much bolus insulin you are currently using with your "carnivore diet" and which basal insulin you are using? I imagine it is easier with split dose Levemir than it would be with a very long acting insulin because you can increase your morning dose to cover some of the protein, but keep your night time dose as low as you need it to be. I follow a low carb way of eating and the lowest I have managed to go with my bolus insulin is 4 units.in a day. To give some perspective, I need about 25-30 units of basal a day split 20-24u in the morning and 0-7u at night and average bolus insulin is about 10u. If I was really focused and organized I might manage to get it down to zero bolus but I would have to spend a lot more time on it and I am not sure it is worth the commitment, just to say that I have done it..... well maybe.... 🙄 ..... as a one off, but not sure I could sustain it and as I mentioned above it would be a waste of resources because I would still need the Fiasp for if I was ill or injured or my levels went up for some other reason, like they did after the Covid vaccine.
 
Elmas said:
Hi John,

I’m very interested in know how you’re doing this. I’m currently following Dr. Bernstein’s methods but with a carnivore diet and would love to try going “basal only” which I’ve heard it could be done. Dr. Ken D. Berry and Dr. Anthony Chaffee have both mentioned doing this for some of their T1 patients on their podcasts. Can I ask you more details? When do you inject your basal? How much protein and fat are you eating per meal? Thank you!
Click to expand...
Hi Elmas,

I am probably averaging about 4 units per day of bolus (Fiasp in my case), although some days I can get as low as 1 unit or even none on two or 3 occasions . Like Barbara says, I think I could get to virtually zero bolus insulin but am quite happy with things as they are, and don't think that the extra time spent and commitment. I inject my basal in the early evening, I've now settled on 18 units of Tresiba (used to be around 30 units before I went low carb), I've been steadily reducing it to avoid occasional lows during the night. I don't actually measure the amount of protein and fat that I eat, I just concentrate on keeping the carbs low, otherwise I just eat enough to satisfy my hunger. I usually only eat 2 meals per day (breakfast and dinner), don't eat lunch normally. If I'm hungry in between I tend to snack on cheese, cold meats, hard boiled eggs etc. I've read Dr Bernstein before, I would imagine that his diet advice would result in very little bolus insulin being used? What is your insulin regime currently?
 
With carnivore I’m using about 6-7 units of Levemir a day and about 4 units of Regular insulin. With Bernstein I was using about 8 of levemir and about 7u of Regular insulin. One of the main reasons I’m interested in the “basal only” approach is because I’m very insulin sensitive so with every little correction there’s a chance I can drop quite fast. 1u of Humalog will drop my bg about 120 (6.7 mmol) points and 1u of R will drop me about 80 (4.5mmol). So if I could “cruise” without that risk it would simplify my life tremendously. Low bg sucks. What I’m trying now is diluting my insulin. I learned that from Dr. Runyan, another doctor with T1. Thank you John.
 
Elmas said:
With carnivore I’m using about 6-7 units of Levemir a day and about 4 units of Regular insulin. With Bernstein I was using about 8 of levemir and about 7u of Regular insulin. One of the main reasons I’m interested in the “basal only” approach is because I’m very insulin sensitive so with every little correction there’s a chance I can drop quite fast. 1u of Humalog will drop my bg about 120 (6.7 mmol) points and 1u of R will drop me about 80 (4.5mmol). So if I could “cruise” without that risk it would simplify my life tremendously. Low bg sucks. What I’m trying now is diluting my insulin. I learned that from Dr. Runyan, another doctor with T1. Thank you John.
Click to expand...
Presumably you do have a half unit pen when you are so sensitive to insulin?
 
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