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Newbie not on bolus yet

K

katesypoop

Member
Relationship to Diabetes
Type 1
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She/Her
Hi everyone,
I've been on basal injections since Wednesday (Lantus, one in the evening) and had my CGM since Thursday. Obviously my BG has been high and misbehaving for some time without me knowing but watching it go up (and last night stick around) at 18 is making me feel really nervous. I've got a phone appointment with the diabetic nurse in two weeks to see if I should start on the bolus injections but it feels like a long time to wait and see all the data of how out of range and up and down my BG is. I guess I'm wondering if I should just be patient and see if the basal starts levelling me out or if I should try to see the nurse sooner?
Thanks in advance
P.S. I hope I got basal and bolus the right way round, I wish the words weren't so similar haha
 

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katesypoop said:
Hi everyone,
I've been on basal injections since Wednesday (Lantus, one in the evening) and had my CGM since Thursday. Obviously my BG has been high and misbehaving for some time without me knowing but watching it go up (and last night stick around) at 18 is making me feel really nervous. I've got a phone appointment with the diabetic nurse in two weeks to see if I should start on the bolus injections but it feels like a long time to wait and see all the data of how out of range and up and down my BG is. I guess I'm wondering if I should just be patient and see if the basal starts levelling me out or if I should try to see the nurse sooner?
Thanks in advance
P.S. I hope I got basal and bolus the right way round, I wish the words weren't so similar haha
Click to expand...
Hi and welcome, I’m fairly new to type 1 just under a year. When I was first diagnosed was put on both basal and bolus at the same time. Can’t really give you much advice, but I’m sure someone will be able to
 
katesypoop said:
Hi everyone,
I've been on basal injections since Wednesday (Lantus, one in the evening) and had my CGM since Thursday. Obviously my BG has been high and misbehaving for some time without me knowing but watching it go up (and last night stick around) at 18 is making me feel really nervous. I've got a phone appointment with the diabetic nurse in two weeks to see if I should start on the bolus injections but it feels like a long time to wait and see all the data of how out of range and up and down my BG is. I guess I'm wondering if I should just be patient and see if the basal starts levelling me out or if I should try to see the nurse sooner?
Thanks in advance
P.S. I hope I got basal and bolus the right way round, I wish the words weren't so similar haha
Click to expand...
Hi Kate and welcome to the forum though we wish we did not have to register here.
You have got your terms correct as Lantus is a basal so giving a background insulin and bolus is what you take for meals so much shorter acting.
I understand that you want to get your BG under control ASAP but I really would not worry as it is a marathon not a sprint and in fact it is better to bring your BG down gradually in the early days following diagnosis in order to lessen the risk of damaging your eyesight.
They will sometimes start you on a basal only to see your body reaction and also to see if you can get some consistency re dosage which will help you later.
I was started on 2u of basal and 2u of bolus just to start off but I had an appointment with DSN within days and am sure when you see yours you will get much more relevant advice fir your own situation.
BW for the future
 
PS I presume you were told to check your ketone levels if you spike certainly above 15 which you obviously are just to be on the safe side.
 
I’d phone them personally. I don’t understand the logic of basal only. It just causes more stress and doesn’t actually help much. I’m sure the guidance for Type 1 says people should be started on both - ie a basal/bolus regime.

Tip to remember: basal is the long-acting slow insulin that ticks away in the background, controlling your blood sugar in the absence of food - ie the base.
Bolus literally means a lump and is the shorter acting fast insulin that deals with your meals. The word bolus is usually used for lumps of chewed food. If that alone isn’t enough to help you remember, then you can use something like ‘bolus = bowl ie food.
 
Wendal said:
PS I presume you were told to check your ketone levels if you spike certainly above 15 which you obviously are just to be on the safe side.
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I was told not to test above 15 unless I didn't feel well, as the strips were expensive. But maybe I will start just for peace of mind. Thanks for your advice, I'm defo in no rush to start the bolus but just want to keep myself safe
 
Inka said:
I’d phone them personally. I don’t understand the logic of basal only. It just causes more stress and doesn’t actually help much. I’m sure the guidance for Type 1 says people should be started on both - ie a basal/bolus regime.

Tip to remember: basal is the long-acting slow insulin that ticks away in the background, controlling your blood sugar in the absence of food - ie the base.
Bolus literally means a lump and is the shorter acting fast insulin that deals with your meals. The word bolus is usually used for lumps of chewed food. If that alone isn’t enough to help you remember, then you can use something like ‘bolus = bowl ie food.
Click to expand...
Ah that's great I was trying to find some similar words to help me remember. I think they might have just started me on basal because I'm still waiting for the antibodies test to come back? I will try to give the nurse a call next week
 
katesypoop said:
Ah that's great I was trying to find some similar words to help me remember. I think they might have just started me on basal because I'm still waiting for the antibodies test to come back? I will try to give the nurse a call next week
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Ah, ok. I saw your Type 1 avatar and thought you’d had the Type 1 confirmed. Either way, if you’re Type 2, you might need a bolus insulin anyway as you’ll probably find it makes a big difference to your spikes.
 
katesypoop said:
I was told not to test above 15 unless I didn't feel well, as the strips were expensive. But maybe I will start just for peace of mind. Thanks for your advice, I'm defo in no rush to start the bolus but just want to keep myself safe
Click to expand...
Obviously go off what the experts advise but personally I would test irrespective of how I felt if I was above 15.That was certainly what I was advised and as for the ketone urine dip sticks being expensive is a nonsense as they really are cheap as chips.
 
When people ask me about testing for DKA I always say the whole blood test is always the gold standard but the urine dipsticks are absolutely fine and cost about £5 for a pack of 50 so by far the much cheaper and easier option.
 
Wendal said:
Obviously go off what the experts advise but personally I would test irrespective of how I felt if I was above 15.That was certainly what I was advised and as for the ketone urine dip sticks being expensive is a nonsense as they really are cheap as chips.
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Yes, the Ketostix to dip in urine are relatively cheap but the individually wrapped blood ketone strips that are prescribed to be used in a dual BG/Ketone meter are much more expensive.

You don't need to test if your levels spike up to or above 15 but if your baseline level is above 15 then it is a good idea to check.
Food spikes that come down again are not a concern.
 
Hi @katesypoop and welcome to the forum - I too don't understand the simply basal approach, but hey. I'm not a doctor - the antibody tests take a couple of weeks to come back and if your numbers are stubbornly high (as they seem to be from your graphs) I'd definitely give your healthcare team a call to discuss perhaps a change of tack - it is important to bring the numbers down gradually though - maybe that is their reasoning for the basal only approach? I hope it all settles down for you and if you have any more questions, please fire away - a diabetes diagnosis (even though it's not quite clear yet) can be quite daunting but there are many people on here who have had a similar journey - we''re all here to help each other
 
May I ask @katesypoop the diabetic nurse, is she based at your GPs or the hospital clinic?
 
Hi. As a T1 you should be started on both Basal & Bolus and also be given a CGM. You could wait the 2 weeks to see the DN and in the meantime keep the carbs down. When you see the DN do ask for a CGM and also ensure you get the Bolus insulin.
 
I’m another who thinks starting on basal (base) and bolus together would be better. It’s what NICE recommend for new cases of T1.

It might feel a bit overwhelming to add another insulin, but you’ll get used to it really quickly, and you’ll be able to adjust each insulin to do its job - rather than trying to get your basal insulin to try to cover your meals as well (and then be far too much overnight when you aren’t eating.
 
I wonder if they are doing 'treat as t2 until proven t1 thing...i was started on metformin and glicazide then when type 1 confirmed straight onto bolus/basal. Mind you, if you have libre prescribed, seems they are pretty sure...
It may borth avoiding really high carb food til you are are bolus/basal but best not to make to radical changes
 
Tdm said:
I wonder if they are doing 'treat as t2 until proven t1 thing...i was started on metformin and glicazide then when type 1 confirmed straight onto bolus/basal. Mind you, if you have libre prescribed, seems they are pretty sure...
It may borth avoiding really high carb food til you are are bolus/basal but best not to make to radical changes
Click to expand...
I was started on gliclazide but it didn't seem to do anything, and was told to stop when I went onto the lantus. They've added "Type 1" diagnosis onto my NHS app and the specialist said she is almost certain I'm Type 1, but yes I do wonder if it's because they are waiting for the antibodies test. I'm told that can take up to 4 weeks so still have a while to wait to get that back
 
Thanks everyone for your help and advice, I spoke to a GP and they still don't want to put me on bolus but have upped my Lantus by 2units 2 days ago (now on 12 in the evening). It just feels like my BG is not improving at all I'm spending hardly any time in the "green" on the freestyle libre. My a1c went down to 79 a few days ago but is now back up to 83. I have an appointment with the diabetic nurse next Thursday, hopefully things will have improved by then.
 

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Have you been referred to a specialist Diabetes Centre? They are usually based at a hospital - you need to see a Diabetes Specialist Nurse (DSN) really IMO, not just a nurse based at your GP (who may just have an interest in Diabetes, like the one at my GP surgery) - they are able to prescribe, just like doctors, as they have substantial training and expertise in Diabetes, and will undoubtedly know more about Diabetes than even your GP
 
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