All basal, no meal time insulin

Hi guys! I was diagnosed with Type 1 about a month and a half ago and a few weeks ago I started experiencing much more "normal" blood sugars and a decreased insulin requirement. I'm assuming that I'm entering the honeymoon phase?

My question is, though, has anyone ever been solely on basal insulin without any meal time doses? I've been taking Lantus (at most 20 units, although I've been decreasing it almost on a daily basis because of frequent at 16 units and I'll probably try 15 tomorrow) and I've started exercising again (nothing crazy - just some basic strength training or yoga). It's also worth mentioning that I have a very active job in physical therapy, so I'm always walking around and/or lifting things. I hardly sit at work. I haven't had a blood sugar high enough to warrant a Novolog injection before any meals. I've been able to keep my BGs between 80 and 120 for the most part. I have had pretty frequent lows though (mid to upper 60s), including one scary one where my lips and mouth went numb (I have a feeling it was lower than 60!).

I'm wondering if my basal dose is way too high. I'm gaining weight slowly, which I know shouldn't be my main concern right now, but I'd rather not gain weight if I don't have to! I'm getting married in a few months and at my dress fitting, it was already tight! :(

My doctor has me on a sliding scale for Novolog, which only requires an injection if my BG is above 150 before lunch and/or dinner. Since it hasn't been, I haven't taken any for a while.

What do you guys think? Should I decrease my Lantus to the point where I require Novolog?

I was exactly the opposite for the first 18 months after diagnosis. I needed no basal, but had to bolus. How long do you go between meals and how low does your BG go? If the 60's are common between meals, it sounds like you're having to eat to your basal insulin, which may be why you're gaining weight. If it were me, I'd lower my basal until my BG was staying more like 80 or 90 between meals and then bolus for meals if I found my BG was going too high after the meal. I think a sliding scale for bolus is somewhat difficult to work with. For me, it was much easier from the beginning to figure out my I:C ratio and bolus for exactly the carbs I was eating. Another thought regarding weight gain might be to ask your endo about switching to Levemir. It's reported to be less likely to cause weight gain.

There are so many moving parts, right!?!

SO many moving parts! It's hard to keep up. I usually go 4-5 hrs between meals, although in the afternoons I have a snack to keep me going until dinner, since I work in the afternoon/evenings and otherwise it would be 6 hours between lunch and dinner. But I find myself snacking more often - even when I'm not hungry - just because I can feel myself going low (and my BGs support that).

Such a huge difference compared to a few months ago, where I was eating whatever I wanted all day and still losing weight. Is it bad that I miss that part a little? Even though it was a symptom of my diabetes? Hahaha

Welcome to the "D" world! My situation is similar to yours. Last year in June, I was correctly diagnosed as a type. 1. At that time my blood sugar average was around 200. Endo started me out using 30 units of long-acting insulin. Bolus for meals with fast acting insulin if blood sugar was above 150 using the sliding scale. Like you, I have a very physical and active job. I was starting to experience some bad lows. On my next visit with the Endo, two months later. He saw the improvement in my blood sugar levels. He ended up lowering the basal insulin down to 20 units a day, split in 10 units twice a day.

After another month or two of watching what I eat during the day. I noticed that I was having more pre-meal readings below 150 than above 150. There were times when I was going to eat something that I shouldn't, I would give myself a bolus shot. Even if the BG was below 150. Depending on what I was going to eat, and knew how high the food would shoot my sugars up. I would inject 2 units fast acting to cover those carbs.

In January of this year I started on the pump. What a BIG difference that has made for me! Feel like a new person! Since being on the pump, my daily basal rate is 13.8 units. I average around 20 units of insulin a day total, less on days when I am off from work.

Before I was first diagnosed in 05, I lost about 30lbs, in about a two months time frame. I dropped from 180lbs to 150lbs. After being diagnosed as a type 2. The doctor at that time placed me on medication to control blood sugars. After 4 months on meds. my normal weight came back. After several years, additional meds were added to control blood sugar. Seems like the extra meds caused me to gain weight. Ended up topping out at 200lbs. I never could loose that weight no matter how hard I tried with diet and exercise. During that time, I always felt bad, like having a hangover, everyday. After awhile things got worse for me until I found an endo that correctly diagnosed me as a type 1. After starting on insulin, within two months my weight dropped from 200lbs to 165lbs. And I wasn't even trying to loose the weight. My wife says that my sudden weight loss was "like I stepped into the shower and the weight washed right off of me." So far since starting on the pump my weight has been very stable and holding around 165lbs.

hello! i was also diagnosed as an adult with t1. at diagnosis i was started on 15 units of long acting and a sliding scale. i found that i needed WAY less insulin. i experienced lows every day with such high doses of the long acting and injecting using the sliding scale, which didnt take into account my personal insulin sensitivity.

i started scaling back on the long acting and was eventually on 2UNITS of long acting within a couple of weeks of diagnosis. i guess my beta cells got back to working after a short break with the exogenous help. it could be that your dose is too high, especially if youre getting to your next meal low, as the basal is meant to keep you steady over the course of the day.

i also did not need any bolus for most meals. i tried to eat lowish carb at all times and was also very active.

my use of basal has increased these past three and a half years and is now at 14 a day. last summer, due to the heat, i was down to 8 units. i need bolus now for some meals now. it has gotten harder to control in the last year so i suspect it is because my beta cells are really kaput now.

i started on lantus and changed to levemir 6 months later because lantus always gave me pain at injection sites. some people call it fatlantus and say levemir doesnt promote weight gain like lantus does. maybe you could try switching? i inject it twice a day instead of once, but i prefer that to having a sore leg for half an hour.

of course we arent doctors but i think you might talk to him/her re lowering your basal so that you can use basal. i would also speak to them about carb counting so that you can get off the sliding scale. helpful books are "using insulin" by walsh and "think like a pancreas" by scheiner. they (and this foum) really helped me at the beginning.

good luck with everything and congratulations on getting married!

My question is, what’s your BG after a meal? If it spikes over 140 (some say 120, others 180) then I think you should bolus for meals (I’m not a doctor). The evidence points that the spikes are what cause complications and not your pre-meal bg. If you haven’t read “Using Insulin” or “Think Like a Pancrease” It would be worth your time.

I was diagnosed about a year ago and started with 20 units of Lantus without bolus. I was trying to go low carb and avoid bolusing since I’m a needle phobe. That lasted about 6 months before I begged to be put on a Humalog regimin too. I’m now bolusing and my Lantus has dropped to 11 units.

Good Luck.

I’m intrigued by “the evidence points that the spikes are what cause complications.” Care to share that evidence?

You should probably talk to your doctor about 1. Lowering your lantus dose 2. Going on an insulin to carb ratio, you should be taking novolog based on your carbs, not your blood sugar, that's really bad for you. Like you should be taking 1 unit of insulin per some amount of carbs (usually you get started out around 15-20 carbs and it's based on a lot of math, Think Like A Pancreas can also help you determine your own) . like if you get an insulin to carb ratio of 1:20 you'd take 2 units for 40 carbs.

I don't know if it's the honeymoon, it just sounds like you're on a super high lantus dose and not bolusing for food at all which can do crazy stuff to your blood sugar. I know because I was started on lantus first , but I was on a smaller dose than that. I started with 10 and it didn't heavily change my blood sugars, just made them more stable and I didn't spike as heavily. I have to be on both and most type 1's need both unless they're REALLy in a honeymoon but even in a honeymoon most people use a tiny dose of fast acting and a small dose of long acting as well. Like you have to do both basal and bolus (using an insulin to carb ratio) and balance your doses with experience after trying it .

After meals, it rarely goes above 120. I eat about a 40/30/30 ratio overall (fat/carb/protein), although I'm not sure how much that has to do with it. Yesterday I actually tried 14 units of Lantus and I was STILL in the 70s all morning, even after eating. And then after lunch (about 40g of carbs) I went up to a whopping 92 mg/dl (that was supposed to be sarcasm).

I took a leap of faith and tried 10 units this morning. I'm starting to forget what my Novolog pen looks like. Maybe it'll make an appearance today, haha.

Yeah, the Lantus hasn't been keep me stable at all - just causing me to try to fight off low BGs all day. I feel woozy and jittery at the same time, most of the time - like my BG is plummeting constantly.

I have Think Like a Pancreas, which I think has been a huge help. Although I haven't taken action with most of his stuff because I want to talk to my doctor first, who I see on Tuesday. But honestly, if my doc doesn't support the basal/bolus method, I might just be like...tough ■■■■, I'm doing it.

go on with your bad self.

It definitely sounds like your Lantus is helping cover your meals, which it really shouldn't be, at least not to the extent it is. Just for comparison, when I was on zero basal, if I ate 40g of carbs with no bolus, I would have gone up at least 200 points over where I started. I know T1 shows up differently for each of us, especially in the beginning stages, but I have a feeling you'll start to feel a lot more in control of your BG & your life in general if you move to less basal and add some bolus.

I've had Type 1 for 26 years now. Well past the honeymoon stage. But recently I tried the same thing. I almost doubled my daily Lantus dosage but not only that, am actually injecting it twice per day, Midnight and Noon at the same time to keep in consistent. My experience was that it's a stronger effect the first 12 hours and not evenly over 24 hours. So two injections of Lantus per day is helping. I was taking Lantus 14 once per day and now Lantus 12 twice per day. So the total daily is equivalent to 24. But this require cutting the Humalog big time, or you'll turn low. I increased the Insulin to Carb Ratio from 6 to 10. But what I found out to my surprise, is that physical exercise can effect your sugars to the downside even a full 24 hours after a workout. I used to think it only effected sugars within 8 hours after hitting the gym. So my higher Lantus dose of 12 at Midnight and Noon, I now cut back to only 8 at Midnight and Noon after an evening at the gym. If you have a physical job and then you have a few days off and not that active, your blood sugars will be high a day after you're off work for the weekend. Higher Lantus twice per day, cutting back after exercise, lower Bolus with Humalog, and I also scale the time I give Humalog before a meal 15 to 45 minutes depending on the sugar level, if high before a meal, then I wait 45 minutes, if not high, then just 15 minutes before a meal. This counters the Post-Meal Spike, especially at lower Humalog doses. Experiment with that, but it'll become even more important when the honeymoon easy phase is gone.

So I saw my endo Tuesday, and got the usual 'tude he likes to give me (I'm not a fan of him, if you can't tell). Told him that the lantus causes burning when I inject it sometimes and he gives me this look and goes, "people rarely complain of burning with lantus. It's very uncommon." Hm, ok, but I'M experiencing it so who cares about the majority of your patients?? He didn't support me switching to levemir.

The only time I felt like he took me seriously was when he asked what exactly my lows were, and I said 60s. Then he actually paused - I think I caught him by surprise. He said I could continue to decrease my basal until I got rid of the frequent lows. I like the suggestion Shadow gave - finding a basal dosage that keeps me in the 80s/90s range in between meals. So I'm going for that.

Also, the endo said it was completely normal for honeymooners to only take basal and not need boluses. I thought that was interesting...I did check back with Think Like a Pancreas to see what Gary mentions about honeymooners and he says something similar about how it's common to need only basal or only bolus, but usually not both. Hmmm....