Insulin doses...

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Robster65

Robster65

Senior Member
Relationship to Diabetes
Type 1
Hi again.

Since reading advice on various websites about insulin doses, especially for DAFNI (sp.?), Ive been wondering about my basal/bolus amounts.

When I started on the humalog/lantus I set the lantus at a level which remained fairly stable overnight and worked from there. Since then, I have played about with the levels a few times by a couple of units either way as my life has changed.

I'm currently on 14 units of Lantus, with a view to reducing to 12 from tonight.
My humalog varies from 12 to 14 in the morning. 10 to 14 at lunch and 12 to 14 in the evening.
Bearing in mind I'm eating 45g for breakfast, 50-80g at lunch and 60-100g in evening meal with occasional snack as required.
We are going for low GI where possible and things seem not too bad but the lows are becoming more frequent, hence the lantus drop.

How do the doses compare to others and do you think the lantus should be higher, with lower humalog ?
No doctor or nurse has ever really queried it but the humalog always seemed high compared to the lantus.

Rob (still learning)
 
ps. Off out for a walk shortly so apologies if I don't reply. 🙂
 
C being a teenager, she needs a little more insulin and she's on NovoRapid and Levemir, but here goes:

Breakfast usually about 12u - 6cp x 2
Lunch (not during hols) about 10 - 12 u, cp x 1 1/2
Evening again about 12 -16u, cp x 1 1/2, depending on what she has for pudding
Of course, if she's high, she has 1u per 3 to bring her to acceptable levels.

Levemir 20u at 9pm

So you see, you're not much different to C.😉
 
Hi Rob, there are some formulae to estimate what proportion of your insulin should be long acting - I think it's meant to be half of your daily total number of units. However, this doesn't fit my doses, I have about one third of it as my long acting. I think it varies a lot with BMI, activity levels, metabolism etc, and obviously no model will fit all people. So, if it works for you, stick with it!
 
Thanks Monica, that sounds very similar on the bolus. My basal is still quite low, but maybe it's an age thing or just the way the levemir works.

It's great to have this forum to ask things like this because I have never met any other type 1 diabetics I could really ask.

Rob
 
cant help rob ...but have to agree great to be able to ask fellow T1 ...share the knowledge and all that xx🙂
 
insulin doses

Hi Rob,

I only learnt fairly late in the day that 5g of CHO should be balanced against 1 unit of short-acting insulin, so 45g for breakfast would equal 9 units of insulin. This is a rough approximation as types of CHO (high/ low GI) and exercise all play a part but it works for me. I have 6 units of my fast-acting insulin for breakfast and approx 30g of CHO.
Hope this helps,

Robster65 said:
Hi again.


Since reading advice on various websites about insulin doses, especially for DAFNI (sp.?), Ive been wondering about my basal/bolus amounts.

When I started on the humalog/lantus I set the lantus at a level which remained fairly stable overnight and worked from there. Since then, I have played about with the levels a few times by a couple of units either way as my life has changed.

I'm currently on 14 units of Lantus, with a view to reducing to 12 from tonight.
My humalog varies from 12 to 14 in the morning. 10 to 14 at lunch and 12 to 14 in the evening.
Bearing in mind I'm eating 45g for breakfast, 50-80g at lunch and 60-100g in evening meal with occasional snack as required.
We are going for low GI where possible and things seem not too bad but the lows are becoming more frequent, hence the lantus drop.

How do the doses compare to others and do you think the lantus should be higher, with lower humalog ?
No doctor or nurse has ever really queried it but the humalog always seemed high compared to the lantus.

Rob (still learning)
Click to expand...
 
Hi Rob, there are formulas (as others have said) that say roughly what ratio you basal to bolus should be, but I am always of the opinion that you do what works for you - not what a theory says!

I take 17u basal (split 12u am, 5u pm) and my bolus amounts change every day depending on what I've eaten. I have a ratio of 1u:4g in the morning (6am- 11am), 1u:7g midday (11am - 4pm) and 1u:10g in the evening (4pm - 6am). So in theory if I have a HUUUUUGE breakfast, I could be taking way more than half of my total daily dose in bolus!
 
I would get on a DAFNE course, I think it would help alot with the theory of how insulin effects you Blood Glucose, how long it lasts and so on.

If your Lantus dose holds you steady overnight you have it bang on...so keep it there.

You will need to find out when your getting the lows you speak of.

If its at lunch time you may be taking to much insulin at breakfast, I will be suprised if thats the case as almost everyone is more resistant in the morning.

Theres lots of things to consider when working out doses though,

Carbohydrate Portions (1 unit of quick acting insulin to 10 grams of Carbohydrate)

Insulin resistance (in the morning you may have to take as much as three times the normal dose),

Correctional doses (1 unit drops you down 2-3mmol/l, if your above 12mmol/l you may have to assume 1 unit drops you down 1-2mmol/l)

These are all DAFNE principals, if you cant get on a course its still good to know these basic behaviours of insulin on sugar levels....

When do you get the lows?
 
wow. Thanks for all the replies. All positive stuff.

I was offered a DAFNE course where I lived about 2 years ago but couldn't make it and now the nearest place is about 1.5 hours drive away. We've been scouring the web for various snippets but while I'm trying to lose weight and build up fitness, the days are a blur of walks and tests !🙂
I had read about the basal being half the dose, which is what got me thinking. Mine has never been anywhere near that.

I've been getting lows all over the place, generally because we were experimenting with doses and extra carbs for exercise but the biggies were in the night, so I've lowered my basal by 2 units and I was 10.8 this morning after having a slice of toast as supper. Previously, 2 slices of toast and I was still waking at 4am with a 'low' on the test meter ! That's what a bit of exercise can do for a tired body. 🙄

I've spent years (decades) trying to get the BS steady and only recently read about insulin resistance and the varying ratios through the day. It's something I've now seen for myself with the rigorous testing and playing about. I think we need to fix some ratios under set conditions and then try using them without referring back to our little notebook.
Hopefully getting some more test strips today, so can go mad with them for a couple of days.

Will report back. Thanks again everyone. My mind is a bit easier.

Rob
 
Thats the spirit rob............

You mentioned excercise there which unfortunately does affect sugars.....there is a section on here about it with links to websites that tell you how much to drop your insulin both basal and bolus by with different severities of exercise..

http://www.diabetessupport.co.uk/boards/forumdisplay.php?f=15

Look forward to the update!
 
cheers novorapidboi. 🙂

I think I've read everything there is to know about exercise over the years. I get the theories but the practice never seems to be right for me.
I guess until the basics are steady, the adjustments won't have the desired effect.

I have the Diabetic Athletes book that gives all the advice for any activity you can think of. I used to rock climb and never managed to get it right, maybe because the adrenalin threw everything off balance. I tended to lurch from highs to lows and hope it would average out. Plus of course, the fear of a low half way up a crag meant I used to deliberately stay on the high side.

Thanks for all the help and advice.

Rob
 
My basal is currently about 20% of my total daily dose - I have 8 units of lantus and about 28-32 units of novorapid. When I was first diagnosed I was on 20 units of lantus, but had to drop it considerably about 10 months after diagnosis. My novorapid also decreased, but not by the same proportion.

Exercise is soooooo difficult to get right on insulin! 😱 I can quite understand you not wanting a hypo up a crag!
 
If you're concerned about hypoing up a crag, then look at www.diabetic.friendsinhighplaces.org (Mountains for Active Diabetics) to see how others tackle the issue - worth joining email group, as website is a bit quite. Plenty of people there keen to get you back climbing!
 
🙂 I suspect my dangling days are over. We have our own rock faces in the garden (rock and gorse feature heavily in these parts). I clamber up the 5m when I feel reckless. :D

I'd love to get climbing fit again but I'm currently awaiting a Carpal tunnel op and have trigger figure in a couple of joints. I gave it up shortly after sumersaulting from halfway up the stairs when I hypoed and convulsed (I do that sometimes). Came to at the bottom, legs akimbo pointing upwards and found I'd smashed the hall table with my right shoulder. 2 years later I got a frozen shoulder for a year so I may be pushing my luck just leaving the house. 😱

Then there's the knee ligaments that sometimes play up after over-exerting on a hike up and down Helvellyn. If I was a horse, I'd be shot by now. 🙄

Rob
 
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