BASAL OR BOLUS

[mum2westiesGill]

My previous DSN sent me a letter ages ago but I've lost it - it was to confirm that (without basal testing)

If waking BGLs are constantly high or low increase or decrease basal insulin

If it's mealtime BGLs increase or decrease fast acting insulin at the meal before ie if lunchtime BGL's are constantly high or low increase or decrease breakfast time insulin

Can anyone confirm this for me please?

 

[everydayupsanddowns]

I can see the reasoning, but that isn’t how adjustments work for me personally.

Over the years (both on MDI and pump) I have observed that my meal ratios and correction factors tend to stay more stable through the year.

Once I had my basal adjusted right (by basal testing), and my meal ratios working well, it seemed that when my meal doses stopped working as expected, all I needed to do was make a small adjustment to my basal insulin to get the meal doses to behave again. If over a number of weeks or months my basal needs consistently moved in the same direction, eventually I may need to adjust a ratio up or down by 10%, but most often for me it is enough to keep tweaking my basal.

It feels as if my basal and bolus work together… and for example if my basal is not quite enough, then a proportion of my meal doses will get used to cover the gap, so there won’t be quite enough left for the meal - if that makes sense?!

 

[mum2westiesGill]

I can see the reasoning, but that isn’t how adjustments work for me personally.

Over the years (both on MDI and pump) I have observed that my meal ratios and correction factors tend to stay more stable through the year.

Once I had my basal adjusted right (by basal testing), and my meal ratios working well, it seemed that when my meal doses stopped working as expected, all I needed to do was make a small adjustment to my basal insulin to get the meal doses to behave again. If over a number of weeks or months my basal needs consistently moved in the same direction, eventually I may need to adjust a ratio up or down by 10%, but most often for me it is enough to keep tweaking my basal.

It feels as if my basal and bolus work together… and for example if my basal is not quite enough, then a proportion of my meal doses will get used to cover the gap, so there won’t be quite enough left for the meal - if that makes sense?!

Thanks @everydayupsanddowns for your reply. The only insulin I seem to up or down just lately is my basal. I've been on 1:10 for agesssss now and recently DSNs seem to always say to just tweak my basal and that nothing else needs altering - I don't know if I should be happy or sad about this

 

[everydayupsanddowns]

Thanks @everydayupsanddowns for your reply. The only insulin I seem to up or down just lately is my basal. I've been on 1:10 for agesssss now and recently DSNs seem to always say to just tweak my basal and that nothing else needs altering

Yes, I find that works well too.

Sometimes I need to make slight meal adjustments (eg if we have eaten the same meal on previous days and my dose came up a bit short) and occasionally if things have got really chaotic I will need to work through and check and update everything… but more often than not a small basal tweak seems to be enough to get things behaving themselves again.

 

[mum2westiesGill]

Yes, I find that works well too.

Sometimes I need to make slight meal adjustments (eg if we have eaten the same meal on previous days and my dose came up a bit short) and occasionally if things have got really chaotic I will need to work through and check and update everything… but more often than not a small basal tweak seems to be enough to get things behaving themselves again.

I suppose it was a a slight meal adjustment that I made on a couple of days this week - at breakfast time I took just half a unit extra because I've had a few days where my lunchtime bgl has been high. If my lunchtime bgls go back to not being high again then I will stop adding the half unit on at breakfast time. Do you think this sounds ok?

 

[everydayupsanddowns]

That’s pretty much what I did this morning!

I had extra toast yesterday, and the dose didn’t work as planned - so I added a little extra this morning rather than needing a correction mid-morning.

I tend to find smaller adjustments given earlier work better than if I have to wait until I’m already high and sort that out.