Bolus and Basal troubles

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Silent Sands

Silent Sands

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Relationship to Diabetes
Type 2
Worried about the amount of bolus I'm taking before breakfast - it has risen to 28, and my BG fell to 16.1 two hours later from the morning base of 10.0.

Is this unusual or am I right to be concerned?
 
There is no such thing as too much or too little insulin. The right amount of insulin is what your body needs. So there is no such thing as usual or unusual.
it is not unusual to see your levels rising when you get up. It is common enough to have a name : Foot on the Floor.

If your levels rise in the absence of food (e.g. overnight), you may need to increase your basal.
 
So judging by your reply, I can take 30 units and above for foot-on-the-floor BG readings with no ill effects?
 
Have you done a basal test? If not that's your first port of call.

Also are you sure your insulin is ok and it hasn't been cooked in this heat?
 
Basal is Humulin I, I didn't know you could test for it?
 
Silent Sands said:
Basal is Humulin I, I didn't know you could test for it?
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Mostly for people with Type 1 but I imagine the same thing works for people with Type 2 using a similar insulin regime.
 
My basal works just fine as my BG readings in the evening show. Each evening there're in the range of 4 - 8 repeated night after night.

No, I thought you were saying that there was an extra test that I didn't know about, evidently not.

I can use a different pen if you think it's at fault, but it seems to be working just fine for me. I could be wrong in my thinking.

No, the question was too much bolus but that got answered.
 
Hi. Can you give us some idea of your BMI? If it is a bit high then you may have some insulin resistance and insulin doesn't go well with that as you will probably already have too much insulin in the your blood. Do adopt a low-carb diet if you haven't already and with a bit of luck any insulin resistance will reduce and so will the need for insulin. If your BMI is high, then there are weekly injectables that can be more suitable than insulin.
 
Yes, my BMI is slightly high, about 26. However, I have adopted a low-carb diet and I've been on it since February, this year. My weight is gradually getting lower as well, currently 92Kg, down from 102Kg In February.
 
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Silent Sands said:
Worried about the amount of bolus I'm taking before breakfast - it has risen to 28, and my BG fell to 16.1 two hours later from the morning base of 10.0.

Is this unusual or am I right to be concerned?
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Does seem fair whack of insulin for someone who already low carbs, maybe as your weight decreases things might improve.

Found when I went low carb insulin doses didn't increase but didn't decrease either, only difference being that bolus dose had to be split in two sometimes 3 over several hours.
 
This stems back three or five years and is not a new thing. When I was on single insulin, I'd brought it down to between 7 and10 mmol in the morning.
This time, on duel insulin, the basal is steady away at 14 units in the morning, it's the bolus... that seems to be increasing with breakfast. So I'm thinking to change just what I have for this meal, maybe fruit, instead of heavily processed food. Maybe this will be able to bring my after-breakfast BG down from 21 - 16 mmol, down to not being hyperglycemic.

My weight has been fluctuating lately due to the medications I'm on for psychosis, which actively encourage weight gain.
But I'm watching my carbs again closely, aiming for between 60 and 80 per day, I've done it for five months, and I can do it again.
 
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Since changing my breakfast around to fruit & Coffee, My BG has dropped to 13-17 mmol respectively on only 5 Units of bolus, this doesn't alter much when I have eggs or bacon on toast either.
 
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Since changing what I have for breakfast & the amount of bolus, I have noticed a steady drop of BG to levels of 9-11 repeatedly over four hours. My mealtimes have been spaced out accordingly causing my BG to be in the range of 5-8.

I feel that raising my Basal to two injections a day would help massively in achieving a morning reading that wasn't hyperglycemic in nature, thusly making the post-prandial spike less noticeable after breakfast.
 
Well you aren't on a true basal insulin and I haven't a clue whether Humulin I would take kindly to splitting its dose or not.
 
I surmise that it would have to be a different basal, as Humulin I has a life of just over 14 hours.
 
Silent Sands said:
I surmise that it would have to be a different basal as Humulin I has a life of just over 14 hours.
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Not necessarily. Levemir has an activity profile of 16+ hrs depending on the dose but you can still split it and indeed it was designed to be split. Not saying that you can definitely split Humulin I and you really need to discuss it with your nurse, but for many of us, a split dose basal provides a much more adaptable fit for our bodies than a single dose basal.
 
That's interesting, I'll be speaking to the DSN in a week or so. Also discussing Libre 2, been on it for a fortnight and love it, hoping a regular supply can be prescribed on the NHS... I have serious doubts, but that's the pessimism in me.
 
When my short acting was added I was switched off humulin I to abasaglar which is the longer, flatter profile.
 
Hope you get some good pointers from your DSN @Silent Sands

Might be worth jotting down the things you want to chat through or ask about in a notebook. All too easy for the discussion to veer off at tangents when the nurse starts asking questions on your first topic, and then if you are like me you realise out of a list of 5 things you wanted to discuss, you only remembered 3!
 
rebrascora said:
Not necessarily. Levemir has an activity profile of 16+ hrs depending on the dose but you can still split it and indeed it was designed to be split. Not saying that you can definitely split Humulin I and you really need to discuss it with your nurse, but for many of us, a split dose basal provides a much more adaptable fit for our bodies than a single dose basal.
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Humilin I is an isophane (NPH) insulin, which has a slightly peakier reputation, and some studies show greater risk of nighttime hypos. Some Drs used to recommend a small snack if taking at bedtime.

It’s a conversation for @Silent Sands DSN really, but I would imagine splitting the dose in to 2 parts would be doable, as long as the hypo risk was mitigated, and there wasn’t too much of a dose peaking overnight?
 
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