Calculating Long acting Insulin

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Keithjdonnelly

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Type 1
Whilst Rapid Acting insulin is calculated to carbs intake.
What are the considerations to calculate long acting insulin.
At present I use Nova Rapid, and long acting insulin is Levimir
 
There probably is some calculation somewhere but I believe people are typically started on a conservative dose of maybe 10U daily and then titrate upwards, increasing by 2 units every 2 to 3 days until a steady BG without drops overnight is observed.

To help remove the variability of BG due to eating carbs and adding Novorapid you can do basal testing (there are various posts on this forum about how best to do this). This will let you see if your BG remains stable in the absence of food and Novorapid bolus insulin and will help you determine whether you need more Levemir or not.

Ultimately people end up with basal insulin being around 50% of their total daily insulin (TDD), the remainder being the Novorapid. This will vary between people and will also depend on your diet, exercise, etc.

Hope this helps you a bit! There may well be others on here who have seen calculations, but bear in mind we are all different and there is no one size fits all!
 
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There are various methods to calculate and estimated basal dose base on things like your weight or your total daily bolus. However, these are only a good starting point. The correct basal dose it the one that keeps your bg stable in the absence of anything that would change t such as food, stress, bolus insulin. You can test your basal through basal testing.
 
@Eternal422 I wouldn’t call 10 units a conservative dose! I’m only on 7 units now after 30 years of Type 1! It all depends on the individual. As @helli says, they can do calculations based on weight. Mine was originally done with information they got from the sliding scale when I was admitted to hospital at diagnosis.

@Keithjdonnelly The answer is however much insulin keeps your blood sugar steady and in range in the absence of food. That might be 1 unit, 10 units, 25, 35, or whatever.
 
Inka said:
@Eternal422 I wouldn’t call 10 units a conservative dose! I’m only on 7 units now after 30 years of Type 1! It all depends on the individual. As @helli says, they can do calculations based on weight. Mine was originally done with information they got from the sliding scale when I was admitted to hospital at diagnosis.

@Keithjdonnelly The answer is however much insulin keeps your blood sugar steady and in range in the absence of food. That might be 1 unit, 10 units, 25, 35, or whatever.
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Yes, but with respect, Inka you are on a pump. When I was on 2 x doses daily of Levemir I was on 13 + 12. Whereas now on a pump I'm on just over 9u basal. On injections 10u is quite conservative.
 
Pattidevans said:
Yes, but with respect, Inka you are on a pump. When I was on 2 x doses daily of Levemir I was on 13 + 12. Whereas now on a pump I'm on just over 9u basal. On injections 10u is quite conservative.
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And when I was on MDI , like Inka, I was on less than that. My starting basal was around 4 units an, although it went up over the years of my honeymoon, it was never as high as 20 units. So, I would agree with @Inka that 10 units is not a conservative dose to start with.
 
Pattidevans said:
Yes, but with respect, Inka you are on a pump. When I was on 2 x doses daily of Levemir I was on 13 + 12. Whereas now on a pump I'm on just over 9u basal. On injections 10u is quite conservative.
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I had similarly small doses on injections @Pattidevans If I hadn’t,I wouldn’t have mentioned it as clearly it wouldn’t have been comparable.

And my point was that “conservative” depends on the individual. Some Type 1s here are on a handful of units of basal a day. 10 units clearly wouldn’t be conservative for them either. I also made a point of saying that the right amount of basal was what you needed, whether that was “1 unit, 10 units, 25, 35, or whatever”.
 
I needed 14u am and another 4u pm on Levemir - but there again I'm nowhere near the body size of Patti - and she knows me well enough to recognise this isn't a catty remark suggesting she's overweight - she's always been several inches taller than me for starters! and the rest of her body follows, even if she were 'skin and bone' she'd never be able to fit in size 10 clothes.

Since I started pumping, basal immediately reduced by 30% (that reduction was automatically made by D clinic starting people pumping) and was gradually adjusted by both of us, to in between 10 & 11. Have only had to adjust it massively the once when I broke my patella and it had to be pinned and wired back together. Very painful, loads of swelling, high ketones - no exercise until after I started physio after 6-ish weeks - increase of basal by 300%, and took about 3 months to gradually wean myself back to my normal doses. I'm now heavier than I was to begin with - above 60kg cos just like my mama, I absolutely do have a fat belly, but there again know I eat a lot more crap (biscuits, cake etc) instead of just occasionally - and get very little exercise generally so have absolutely no-one else to blame for it except myself.
 
Hello, from my experience. I was started on MDI a good 12 years after diagnosis. The “estimated” basal dose at the time was way too much that I was feeding hypos all day without the need for the “actrapid” (as Novorapid was branded at the time.) my instructed basal was a good 60% more than I actually required.
I titrated the dose down.
Despite not being as active as I was when starting on MDI. The basal dose remains the same to this day.

I’d recommend “basal testing” as a base figure on your day off. Best wishes.
 
Very interesting to see how much people vary and it just goes to emphasise how different we all are.

From what I remember I started on something like 24U Levemir, but I was overweight then even after some initial weight loss at diagnosis.

It’s also interesting to see that pump use lowers the TDD too, which I guess makes sense if you are getting a constant drip feed 24/7. Would love to have the opportunity to move to that (and HCL) off MDI to give my poor abdomen a rest! One day hopefully!
 
I was on Actrapid too. It was/is a regular human insulin whereas Novorapid is an analogue insulin aspart. Not a re-branding, a different type of insulin 🙂 When Novorapid and Humalog were first introduced, there was much fanfare about being able to eat as soon as you’d injected unlike the Actrapid where you had to wait 20-40 mins. Of course, that turned out to be rubbish, but there we are. Not much lives up to the hype.
 
Eternal422 said:
Very interesting to see how much people vary and it just goes to emphasise how different we all are.

From what I remember I started on something like 24U Levemir, but I was overweight then even after some initial weight loss at diagnosis.

It’s also interesting to see that pump use lowers the TDD too, which I guess makes sense if you are getting a constant drip feed 24/7. Would love to have the opportunity to move to that (and HCL) off MDI to give my poor abdomen a rest! One day hopefully!
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Let’s just say I was first started on a cloudy basal that needed a gentle roll to mix? (In a novo pen.)
The numbers in basal dosage I’m seeing so far are not near what I was instructed to take.
I still struggle to find a 30” waist band that can fit me. (I find they stop at 32” with work wear.)
I was hoping to get a bit more “spread” in my middle age. (No such luck.) I agree we individually have our personal requirements.
 
Afternoon as others have said it can vary and when I was initially diagnosed a few months ago I was put on 2 Units of Lantus and 2 of NR before each meal.
My basal got increased 2 units at a time peaking at 8 and now settled at a steady 6 which gives me a fairly flat line overnight and I top up with 2-4 units of NR with each meal.
I was told that ideally your basal should be about 30% of your daily total but at the end of the day it is what works best for you.
I found running an overnight basal test the best way to decide on most appropriate level and once I was happy with that variable then I moved into individual meal related doses.
ATB
 
Inka said:
I was on Actrapid too. It was/is a regular human insulin whereas Novorapid is an analogue insulin aspart. Not a re-branding, a different type of insulin 🙂 When Novorapid and Humalog were first introduced, there was much fanfare about being able to eat as soon as you’d injected unlike the Actrapid where you had to wait 20-40 mins. Of course, that turned out to be rubbish, but there we are. Not much lives up to the hype.
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I wish I knew how much I started on, but this was all dealt with in hospital by consultant. Initially I was put on mixed insulin twice a day. Had to eat at specific times. This was soon changed to m.d.i.

Is basal dose directly related to your weight, thus if weight increases so does basal?
 
Weight can affect it, yes @Amity Island I struggle to put on weight but I did a few years ago and I found I needed a slight increase in my basal. Other things affect it too, like insulin resistance/sensitivity, hormones, stress, etc. The biggest effect by far for me was pregnancy, which caused a big increase in later pregnancy because of the associated insulin resistance.
 
My basal needs are impacted quite a lot by exercise/activity, particularly my evening dose which needs reducing after exercise and increasing when I am more sedentary and of course any illness causes my basal needs to increase.

I think I was started off on 7 units of Levemir as a single dose and that steadily increased to about 14 by the time I had my DAFNE course 8 months later and split into 2 equal doses of 7u but after my DAFNE I started getting nocturnal hypos and I needed to adjust the evening one down and the morning dose up, plus I had a couple of periods where by basal needs stepped up significantly, presumably as more beta cells died, until eventually I have ended up on 22 units on a morning and anywhere from 0 to 5u on an evening but usually about 3u. This keeps me pretty level most of the time, but my overnight levels are quite volatile and need regular adjustment as I am very prone to nocturnal hypos, even on those small doses.
 
rebrascora said:
My basal needs are impacted quite a lot by exercise/activity
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Soon after I was diagnosed, I attended a talk by the endo who treated Steve Redgrave. He may have type 2 but was being treated with a basal bolus insulin regime. The endo advised reducing basal by 20% for 24 hours after intensive exercise and 10% for the follow 24 hours.
This has been a good guide for me.
I realised it was cumulative when I went hiking in the Himalayas. Every day for two weeks, I hiked at altitude for 6 hours or more. By the end, in order to avoid night time hypos (I was on Lantus at the time which was not split), my basal was less than half of my usual dose.
So, yes, definitely, exercise has a big impact on basal needs.
 
@Inka and @helli, you are slim and very active ladies. @Eternal422 is a chap and likely heavier and therefore 10u may well be conservative for him. However, the point I was making still stands - most people need less basal on a pump than on injections. Whatever, people need what they need and the only way to find that out is to do basal testing.

@trophywench I was a size 10 on diagnosis, but a combination of a mixed insulin regime and advice from a dietitian to make 60% of my meals out of carbs saw me gain oveer 42lbs before I went onto MDI and stopped gaining. Couldn't lose any though. However, since I last met up with you I have lost a lot of weight and am back to a size 12. Thank goodness!
 
@Pattidevans i agree that the dose on a pump is usually smaller than on MDI. But I mentioned my MDI dose not my pump dose.
Regardless whether @Eternal422 is male or female, they may be slight and they maybe very active.
From the threads I have read, it is not uncommon to start with a dose lower than 10 units for men and women and titrate upwards to minimise the risk of hypos and complications from lowering BG too fast.
Considering all of this, I still believe starting on 10 units is not conservative.

But basal testing is on the only way to “calculate” basal needs.
 
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