Increasing isulin when ill: basal vs bolus?

[Lanny]

I’m a bit under the weather at the moment with a cold!

I’m wondering if it’s better to increase basal insulin or bolus insulin for each meal?

I’m on one basal insulin of Levemir a day at lunchtime! I have 3 bolus insulin of Novorapid with meals:- 6, 4 & 4.

The last few times I had illness, or infection, my DSN told me to put my basal insulin up by 1 unit & keep the same bolus doses but, my BS kept rising & I added extra bolus units anyway!

This time I’ve kept the same basal dose & increased the bolus doses & I seem to have better control of BS!

I wonder what others do?

 

[Northerner]

Sorry to hear you are unwell @Lanny As you may know, I don't use any basal any more, but when I did and was ill I would make the decision based on what my fasting numbers were like - so if I was waking much higher (or was higher pre-meal) then that would be an indication that my basal needed tweaking. Also, when under the weather I'm not as active so my insulin sensitivity would decrease, so would more than likely need extra bolus insulin too. I think it's a very personal thing because you are the person who knows your diabetes best 🙂

Hope you feel better soon! 🙂

 

[Lanny]

Sorry to hear you are unwell @Lanny As you may know, I don't use any basal any more, but when I did and was ill I would make the decision based on what my fasting numbers were like - so if I was waking much higher (or was higher pre-meal) then that would be an indication that my basal needed tweaking. Also, when under the weather I'm not as active so my insulin sensitivity would decrease, so would more than likely need extra bolus insulin too. I think it's a very personal thing because you are the person who knows your diabetes best 🙂

Hope you feel better soon! 🙂

Thanks, @Northerner!

That’s very useful to know about fasting BS! My fasting numbers have been coming down & still came down a wee bit this morning! To be sure, is fasting BS the waking one?

I’m adding +2 bolus for meals & the after meals figures are lower. Where as, in the past, with increased basal only, the after meals rise was greater! Which impacted on other meals & I had to increase bolus doses anyway!

I suppose I’ve answered my own question!

My morning BS has taken a long time to come down this past year so, maybe I needed both basal & bolus doses increased when ill! I was also, unknowingly, iron deficient!

Now I’m on iron tablets & my waking numbers are coming down maybe I don’t need the basal increase?

What you say about fasting numbers makes sense to me! 🙂

 

[Sally71]

The last time my daughter was ill (last week actually) she kept going hypo and I had to drop her basal down a bit!! We are all different

 

[Northerner]

To be sure, is fasting BS the waking one?

Yes it is @Lanny 🙂

 

[everydayupsanddowns]

Typically I would increase basal first (either using a temporary basal rate or extra basal profile specially or illness)

This is usually enough for ‘a bit of a cold’ etc.

If the illness has more of a profound effect on my BGs I would also increase meal ratios too.