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To bolus or not to bolus

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Martin62

Martin62

Well-Known Member
Relationship to Diabetes
Type 1
Hi all, I'm new to all this and wondered if anyone could answer my query?
This morning when I got up, my BG was 5.2 mmol, I had my 50g of porridge with water, which comes in at around 34 g of carbs, so I used 3 units of novarapid.
2 hours later I checked BG and it was 4.2 so quickly had a cup of tea and a couple of digestive biscuits which brought it back to 5.8 .
My question is so I need to bolus at breakfast if my BG is ok,if so maybe I should reduce the amount ?
Look forward to your replies
Martin
 
Hi Martin

You sound like you are carb counting. Do you know what your ratio of insulin to carb is? If 2 digestive biscuits (approx 19g carb) only raise your BG by 1.6 then it would seem your insulin was still active 2 hours after your porridge and your BGs were still falling. It does look like you are very insulin sensitive.
 
I would start with checking your basal first.
Tweaking bolus when the basal is wrong will be a loosing battle.

When you are confident your basal is correct, you have not been drinking alcohol recently or working out, then you may need to tweak your breakfast bolus down.
 
When you say you're new to this - how new? a week. a month, a year? (I sound like Eeyore now, but honestly I'm not as depressed as he usually was ..... )
 
I was told to take 15 units of tresiba as my basal, how would i know if this is too much or too less?
 
It’s best to keep in close contact with your DSN as in the early days much tweaking of insulin is required and as you say, you are in a steep learning curve right now.

It could be that the beta cells In Your pancreas have had a bit of R&R due to the injected insulin and are trying their best to get going again , this is called the honeymoon period, it sound nice doesn’t it, but it can be a right pain in the proverbial. No obviously I don’t know if you are going through this as I am no medic , just someone with diabetes.

So please contact your DSN s/he will guide you through the insulin tweaks , also they are probably still trying to work out the ratios you require atm.
 
Well starting doses of insulin are based on intelligent guesswork by medics - only you and your own BG results over a period will tell whether they are correct for your body or not. Did the same happen yesterday and will the same happen tomorrow?

Since then you've had lunch and nearly time for dinner too - so what's happening with your BG now?

And have the Beta cells in the islets of Langerhans in your pancreas entirely stopped producing insulin as yet, or not? Be most unusual for that to happen inside a fortnight.

How long did your BG stay at 5.8?
 
Simplistically, I would say yes @Martin62 - you do need to bolus for your meals.

But as you have already observed, it’s a bit more complex than that isn’t it!

As @helli says, if your basal is significantly higher than you need, then your BGs will be generally trending downwards and the ‘correct’ meal bolus will appear to be too much.

As @Pattidevans suggests, mealtime insulins tend to act over 4-5 hours, with the majority of the action in the first 3 hours, so your breakfast dose still has quite a bit of oomph left mid-morning.

Plus as @Ljc points out, you may have a bit of ‘honeymoon period’ support from your own pancreas adding extra confusion into the mix.

You can get an indication of your basal’s action by skipping a meal and not taking bolus insulin and seeing if your BG remains steady. The differences between bedtime and waking readings can be helpful too, depending on when you ate in the evening.

Hopefully you can speak with your DSN and chat your results through, to get some suggestions on dose adjustments.
 
trophywench said:
Well starting doses of insulin are based on intelligent guesswork by medics - only you and your own BG results over a period will tell whether they are correct for your body or not. Did the same happen yesterday and will the same happen tomorrow?

Since then you've had lunch and nearly time for dinner too - so what's happening with your BG now?

And have the Beta cells in the islets of Langerhans in your pancreas entirely stopped producing insulin as yet, or not? Be most unusual for that to happen inside a fortnight.

How long did your BG stay at 5.8?
Click to expand...
Lots of useful information as usual, but just to clear things up, i have been diabetic for 3 years, firstly treating it with tablets, then moved on to ready mixed insulin shots, then 2 weeks ago started the basal bolus regime, so my honeymoon period is long gone
 
Martin62 said:
Lots of useful information as usual, but just to clear things up, i have been diabetic for 3 years, firstly treating it with tablets, then moved on to ready mixed insulin shots, then 2 weeks ago started the basal bolus regime, so my honeymoon period is long gone
Click to expand...
Not necessarily. The honeymoon period can last years for some people. When did you start on mixed insulin?
 
LADA rather than classic T1 then by the sound of it Martin - everything moves a bit slower
 
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I was a late starter with T1 (effectively LADA) and a recent c-peptide test showed that I am still producing a tiny bit of insulin, and that is thirteen years on. Not exactly still in Honeymoon but I sometimes wonder if they are mucking things up on occasions. But there are so many variables it is just a case of giving what insulin you need.

The Basal Bolus regime will take time to sort out for your personal needs. The basal insulin needs to be sorted first. Which insulin are you using? (Apologies if I have missed that). I found a switch to Levemir for my basal insulin allowed me to split this to a morning and evening dose, and enabled me to adjust without impacting the other. Very useful when I had days of different levels of activity.
 
Hi @Martin62 welcome to the forum. You have my sympathy. I recently had one of them hypo’s that just wouldn’t take the hint and go away, they are horrible aren’t they.
I was shoving a variety of sugary stuff down my throat every 15 minutes like it was going out of fashion. I do wish those glucose tabs tasted as nice as they smell.

I find I have to bolus very conservatively after a bad hypo as I will hypo again , personally I wouldn’t have done a correction during the night but that’s just me .

If you do have LADA, our pancreas often has a verrrry long swan song , mines still producing enough to get me through the night with no active Basal.
 
@Martin62 i was diagnosed as Type 1 from the start with no mention of LADA which I understand is typically longer to get to its “full strength”.
With my Type 1, I saw my insulin needs slowly rising until it stabilised 8 years after I started taking insulin.
Nothing else changed - I did not gain weight, change my diet, do less exercise or get diagnosed with any other medical condition.
I was advised this was my honeymoon period.

As a 11 month insulin taker, you are a relative youngster on this scale so you may still be on your honeymoon.
 
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