Advice on Basal Bolus

Type 1 and LADA
1

Hi there,

It appears from recent months that my basal and bolus doses are screwed as my sugars are all over the place :frowning:

I take Lantus once a day in the evening 25 units
I take Novorapid with my meals, current ICR is 2 units for 10g of Carbohydrate.

I am fairly sure my ICR is incorrect as is my bolus GAH.

I weigh 95kg or 210lbs, I am 190cm and my body fat is around 14%.

Can anyone advise how I can get this sorted? For example I have no idea how much one gram of carbohydrate raises my blood sugar, nor am I able to ascertain the impact of a unit of insulin on my blood sugar.

Any advice on these issues would really be appreciated. What would you be doing in my situation.

Thanks,

Craig.

2

These are very good questions. I think many people struggle with their blood sugars, get little help from the medical profession and are left floating on their own to “fix” things. I’d like to encourage you that you can probably make some significant improvements all on your own. Nobody here can (or should) give you specific dosing advice, but we can help empower you to do this on your own.



First, I’d like to suggest that you get a few books if you don’t have them already (particularly “Think like a Pancreas” and “Using Insulin”). Also, although you say you follow DAFNE, it really helps to be really competent in counting. And actually, many people find that following a lower carb diet really reduces blood sugar swings and makes control “easier.” I keep to under 100 g of carbs a day and almost never have trouble after meals, the smaller meal carb counts and boluses greatly reduce the blood sugar swings.


A good first step when you feel that things have gotten out of whack it to make sure your basal insulin levels are correct. This can be done by performing a staggered set of fasting tests (4-8 hours) throughout the day, a better description is in the books I mentioned. Basically, if your blood sugar rises during fasting, your basal is too low, if it falls, then your basal is high. Better descriptions are in the books I mentioned. You can also read a description of a basal test given by Gary Scheiner the author of “Think like a Pancreas.” Once your basal is set, then you can do analogous experiments to establish your ICR and ISF (Correction Factor).



You can do this, you just need the right information and tools.



…brian

3

Thanks Brian,

I have ordered the books detailed above and am starting a DAFNE course on Friday, I have to have completed this course before I can get a pump here in the UK.

I was thinking that a fast would be a good idea, as I really do think everything needs to be rebaselined. I have had little contact with my diabetes team over recent years, as it took six months to get an appointment and I was moving all over the place. Bad form on my part and a contributing factor to my issues I am sure.

Looking back my doses haven’t really changed in 16 years and I have muddled through changing things here and there and not really getting anywhere.

Hopefully this is the start of getting back on track.

Cheers,

4

I have noticed that my doses change regularly although the last time they seemed to change it also seemed to turn out that it was my pump blowing up and they “reverted” when I got the replacement pump. I didn’t notice this at all until I started keeping track of stuff when I got my pump. It might be beneficial to try to adjust like 1 meal at a time. “Using Insulin” is great but the whole “methodology” sort of revolves around logging stuff and I have never been able to do that accurately, without relying on a gizmo to do it for me. I loathe logging. I don’t mind experimenting with drugs though so to me, it makes more sense to adjust a ratio by a gram and try the new ratio for a couple of days and see how it works out, which works ok if you have a lot of test strips and eat foods that you are confident in the carb count for. If you are taking the classes they help but I suspect that classes will likely direct you to “get a new ratio from your doctor” which, in turn, takes time for appointments. You are better off to “light the candle” yourself I think?

5

Brian,

I received “Think like a Pancreas” this morning and have just finished. An excellent book that is going to be extremely useful with me new basal/bolus regime and my future insulin pump.

It should be required reading for all diabetics.

Thank you so much for the heads up. I will be recommending the book to other members off my diabetes education course.