Which insulin regime do you think is better

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Sylkwood

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Type 1
Hi everyone, I have posted on here a few times and your help is invaluable. I have been wondering lately whether I am having bad reactions to insulin and would like your thoughts on this please.
Do you think it is better to have more basal insulin and then less bolus/ short acting insulin or do you think it is better to have less of the long acting insulin in your system and lower your sugars with more bolus dose. I currently take 74 units of Tresiba per day and then approx 3-4 injections of Novorapid with meals and as blood sugar adjustments.

All views and experiences would be greatly appreciated. Thanks so much,.
 
I think it is best to have the insulin that your body needs when it needs it and to adjust your regime to as closely match what your pancreas would do if it wasn't broken.

This means having as much basal as you need for the liver glucose drip and enough bolus for the food that you eat.
OK, this is an ideal world and ignores the fact that basal needs are not constant for 12 or 24 hours and there maybe something that increases (or decreases) your basal needs for an hour or so such as stress (or exercise).
However, I still think it is not about more of one or the other.
Given the tools you have - a slow acting and a fast acting insulin - the best is to start to get your long acting to match your body's needs in the absence of food, exercise and stress. This is what basal testing helps with .
Once you have this sorted, then you can work out bolus requirements for food (and short stress moments).

I think there are guidelines around basal to bolus ratios but this is very dependent upon what eat and what you do on a day to day. For example, if I have a day when I am very active, I am able to reduce my basal but I am likely to eat more carbs so have more bolus. On another day, I may be unwell or stressed so need more basal but eat little or lower carbs so my basal is greater than my bolus.

The great thing about Tresiba is that it is very long acting so it is flat and constant and changing the time of dosage by a couple of hours each day will have little impact. The downside, is that you are not able to adjust it for daily variations. For this reason, it would not suit me and allow me to take less on the days of activity and more on the days of stress.
 
The best regime is finding a basal insulin which suits your body and your lifestyle and matching the doses to what your body needs to keep your levels stable overnight and/or in the absence of food and then taking as much or as little bolus (meal time) insulin as you need for the food you eat.
I think there is a suggestion somewhere that the balance will usually be somewhere between 1/3 of your total daily insulin as basal and 2/3 bolus to 2/3 basal and 1/3 bolus
Not sure if that makes sense but if your total daily dose is averaging about 100 units then the basal/bolus balance is usually somewhere between 33 and 67u of basal with between 67 and 33units of bolus. I have a feeling I am explaining that about as clearly as mud.. 🙄

For me I would hate Tresiba and I would find it incredibly frustrating because like @helli I need to adjust my basal insulin doses regularly to maintain by balance, sometimes every night. I use Levemir which I inject twice a day morning and evening and is much shorter acting than Tresiba, so it allows daily adjustment. My daytime dose is pretty stable at about 20-22units but my overnight levels are very sensitive to exercise and if I don't adjust it, anywhere from about 5units to zero, I will hypo. When my basal doses are correct for me on any particular day, my diabetes is so much smoother to manage and when my basal dose is even just a unit or heaven forbid two units out, my levels are incredibly frustrating and I either have to eat lots of jelly babies if my dose was too much or inject lots of extra bolus insulin to make up for that unit or two deficit if I didn't have enough basal insulin. Just 2 units too little with my basal insulin can mean I need an extra 9 or 10 units of fast acting insulin to keep me in range that day.

To my mind getting your basal insulin dose right for your body and lifestyle is absolutely key to good diabetes management and how you go about that depends on the basal insulin you have and it is very different for Tresiba compared to Levemir.
Personally I LOVE my Levemir and would fight tooth and nail to keep it if anyone tried to change me, but there are other people who didn't get on with Levemir and find Tresiba very dependable. We are all different and you have to find what works best for you. Understanding the profiles of action of each basal insulin helps as they are not all smooth and even or the same length and that can be a blessing or a curse depending upon your body.
 
The best regime is having the correct amount of basal insulin to keep your blood sugar steady and in range in the absence of food, and then build a bolus regime on that with the correct bolus insulin for each meal (as far as possible).

Which insulin do you think you’re reacting to? The Tresiba?
 
Many years ago my diabetes nurse suggested that the way to think of basal/bolus was:
  • assume you eat no food (or liquid-based nutrients) at all for several days. The correct amount of basal insulin would be that which kept your blood glucose stable over that period/ This amount you would hope to stay fairly stable over long periods
  • when you now start eating again, the correct amount of bolus insulin would be that which keeps your blood glucose stable at and following each meal. This amount would depend significantly on the amount of carbs and sugars (etc) you ate at that meal, so might vary quite a bit
This is almost identical to what @Inka said above! @helli and @rebrascora take the discussion further.
 
In simple terms @Sylkwood ‘you need what you need’.

The amount of Basal versus Bolus will vary day to day: Bolus depending on the size of meals you eat, and Basal depending on many other factors such as the weather, meds, illness, … About 42 different things to take account of.

A fasting basal test is useful to check the basal insulin is correct. Although this is singular I find that it can take a few attempts to cover the full 24 hours.
 
I suppose what I am trying to find out is, can you have too much insulin in your body and yet still have high blood sugars ??
So the insulin is making me feel ill but not lowering the sugars.
 
Sylkwood said:
I suppose what I am trying to find out is, can you have too much insulin in your body and yet still have high blood sugars ??
So the insulin is making me feel ill but not lowering the sugars.
Click to expand...

Some people find some insulins ineffective. So they need to take a disproportionate amount of them to have the desired effect.

There are lots of different insulin options though, including different long and rapid acting ones. Analogues… human… even porcine.

Perhaps you should try some other options?

In terms of basal, you need to set it so that it ONLY hold you level when not eating and with no rapid insulin active. Otherwise delaying and skipping meals becomes difficult. As does the whole basis of carb counting and insulin:carb ratios.
 
Sylkwood said:
I suppose what I am trying to find out is, can you have too much insulin in your body and yet still have high blood sugars ??
So the insulin is making me feel ill but not lowering the sugars.
Click to expand...

Yes, if you’re resistant to it @Sylkwood But high sugars themselves can make you feel ill. I’m intolerant of one insulin. My symptoms were awful aching joints, fatigue, brain fog and stomach pain. I wasn’t taking vast quantities of it, i just didn’t react well to it.
 
Yes I am thinking it could be tresiba that is the problem. just looked up online meds that it can interact badly with, Gabapentin,lisinopril,SSRI antidepressants and propranolol. And I am on all of these. But then I had these weird feelings when on insulatard as well. Maybe time to try something different.
 
Your other option is to see if you can get a pump @Sylkwood You’d only be using fast-acting insulin then. In addition, people usually find they can reduce their total daily dose of insulin on a pump by 20/25%.
 
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