Purpose of basal insulin

[Amity Island]

The way I understand basal is not necessarily to keep one in range. It's to keep ones background glucose steady. Whether you are in range or not depends on where your last meal leaves you. If after your last meal/bolus your reading is 7mmol, then your steady basal will maintain this reading. If after your last meal/bolus your reading is 15mmol then your steady basal will maintain this reading.

Finding the right basal dose to keep one steady is a separate challenge.

 

[Wendal]

Hi Lucy my tuppence worth is basically very supportive of most of other posters in that I see the function of the Lantus overnight is to keep it steady whilst you are asleep.
This is my logic in my insulin management once you have got your levels under initial control.So you have the 3 main inputs so medication ie insulin in my case,diet and exercise.
Firstly get your overnight trend as steady as possible by adjusting your basal to try and achieve that.So for me 6u of Lantus gives me a pretty steady graph and obviously this is the time when normally I don’t have any of the other 2 inputs to consider.
Once I got that steady I concentrated on getting my breakfast,then lunch and finally evening meal inputs as optimal as possible but again obviously the trend is much more up and down as compared to overnight as you have more variables at play but equally you can ( not always) make dietary and exercise adjustments as required.
I then seek to try and ensure I am in as steady a state and at the “ right” level to hopefully have a steady night and wake up to roughly where I want to be.
Like everyone we have the vagaries of the condition and but my 6u Lantus before bed is probably the bedrock of my control and has not really altered.
So if I am high before bed I am more likely to take a correction dose of NR to bring my BG down rather than adjust my Lantus as that will affect my control during the day but others may find different ways of managing.

 

[gillrogers]

At the first day of the T1 course this week the DSN said the purpose of lantus is to drop you to your target BG overnight. On forums I’ve always read that lantus purpose is to keep you steady. Which one is true? I’m guessing it is the DSN but where does the online belief come from if so?

Here’s the two basal tests I did before the course

Test 1: 6pm lantus and dinner. 1030pm start test 14.8. Waking bg 7.5, steadily rose all morning peaking at 14.4 and dropping slightly to 11.9 by lunch

Test 2: 5:45pm lantus and dinner. 10pm 9.0, waking bg 6.0, steadily increased all morning to 11.1 before lunch.

My thought before the course would have been to reduce lantus, but following the principles of the course I checked my average morning bg which was 8.7 and so increased my lantus as well as adding some apidra when I wake up.

Since increasing lantus my waking bgs were 6.6 yesterday and 5.1 today.

So… what actually is the purpose of lantus? To drop you or keep you steady?

Im on the understanding its to do both and deal with anything that raises blood sugars other than food. Ie stress illness and some will laugh but for me definitely weather pressure. Quite often my evening meal wont come back into range so nurse s said use my basal to bring it back into range over night and it does but it i have a basal dose thats half a unit less then it doesnt but i have a steady trace all night but out of range. So in theory i would raise my evening meal bolus dose by half but when i do that, for me, its too much for the meal and i start getting . I trouble within half hoir of my meal. I could do a half unit bolus correction in stead at bed time but that wears off before the night is out and ill start rising back to the level i injected at.

My doc thoight i was nuts doing a written daily diary on my diabetes doses and mealtime readings over the last year with all the problems i was experiencing but its helped me alot to find out what my trigger and influences are for basal and bolus doses for me. Was the right thing to do. It highlighted that the old lispro was far to strong for me, i am extremely sensitive to freshly injected bolus insulin and what my main outside influences other than illness and food are. And i even used it to proove to dsns that i was right with my problems.

 

[Lucyr]

So, whilst my initial basal tests many of you would have interpreted as “need to reduce basal as dropping too much”, I did the opposite and increased it. Now I’m pretty flat overnight, I drop slightly in first couple hours of the night as usually have a bit of apidra finishing off then, but have been a good morning bg consistently now.

This weeks project: daytime ratios and exercise