How much basel dose insulin do you reckon Dr Bernstein takes? I’m just starting a 90-day trial period following the low-carb approach. I’m a newly-ish diagnosed type 1 and have already achieved a certain level of b/s control by lowering my carb intake. I take 17 units of Levemir at night and 1 unit Novorapid per 10 grams carb and I’m trying to do just 30 grams of carb a day. I’m curious to know what doses, especially of basel insulin, other low-carbers take. I split the dose into 5/5/7 units, as suggested by Dr B, but I do take them all at the same time. Look forward to any replies…
Seems like I’m a very similar case…I’m a recently diagnosed Type I and very soon after diagnosis I started the Bernstein diet. I take 5U of Levemir at night and 4U in the morning, and then I take 1-3U Novolog before meals. I’ve been told that I’m particularly insulin-sensitive, which may be the reason that my basal dose is lower, or it could also mean that I still have some of my own B-cells left that are making some insulin. I’m on a constant blood glucose monitor right now since my endocrinologist was concerned that I had too many low blood sugar readings, so they may suggest that I drop my basal levels even further, I’m not sure. Good luck!
It really doesn’t matter what Dr. Bernstein or anyone else takes because everyone’s biochemistry is unique. Doses are based on weight, as well as activity level, other meds taken, insulin sensitivity, etc. There’s little useful info in comparing what you need to what others need. You need what you need.
Levemir is best taken in two doses. It doesn’t last 24 hours. Just by way of example, I take one dose of Levemir before bed & another after breakfast. You’ll need to experiment to see what is successful for you. If you’re having highs between meals, the Levemir may be gone by lunch or dinner.
Fine to take doses at the same time.
I don’t know enough people but I am guessing that because everyone is different (and even if they are not which I doubt, they almost definitely low carb/exercise differently!) then the comment here that different people have different basal requirements is probably right (?). My figures for what they are worth on a very low carb diet (probably less than Dr B’s 30 g / day) are: I take 3 units in the morning and 3 at night giving a total of 6u levemir basal /24hrs. I take 1.5 -2 units apidra the minute I wake up to counter the dawn phenomenon. I eat 2 meals a day of fairly large portions of meat and green veg which i cover with 3.5u human insulin each (total 7u). If my CGM says I am at 90 (5mmol) at any time I (do a check blood sugar and then) take 1/4 - 1 unit apidra to try and bring it back down (apidra is fast insulin I use to “tweek” things as I hate being over 5- bizarre i know but decided I am going to try and deglycosylate everything over the next 7 years!!). I take all this by syringe not a pump (I carry a syringe around each day with around 5u apidra in it and inject 1/4 to 1 units whenever CGM etc suggest - especially if at work i get offered a cup of tea that has milk in (another 3.8g carbo!) tho rare (excepting this example) that I have milk in tea after Dr B!). In total I end up with 16-18 units per day total insulin (basal and boluses) of which 6 units is basal (levemir) as above. These are the figures that just worked out for me with trial and error. I did the starvation routine he suggests in his book a few times over the past 14 months to tweek my basal (wait til you are stable (i.e 6 hours or so - say overnight with no food or significant exercise) then don’t eat for 6-8 hours testing throughout every 1/2-1 hour. If you fall (or rise) during this time even tho not eating, your basal is too high (too low) and can be adjusted accordingly. If you stay flat, your dose is probably great. (Of course it is not quite that simple as basal rates also change through the day and pump users can test these and programme different basal pump rates for different times of day but it worked ok for me to get a ballpark figure and recheck…).
In this month’s (May 2011) podcast, Dr B said that basal doses depend on many things but that it is rare that anyone needs more than 1/3 of their total daily dose as basal insulin. This delighted me as I had not heard him say it before nor do i remember this specifically in his book (?) yet it matched the figures I got by trial and error almost exactly (6u basal out of 16-18u total is basically a third). (The reason i was delighted was that it described me so well and together with the fact that all the figures Dr B has suggested work out well for me on testing them, it just provides more reassurance (were it to be needed) that he knows what he is talking about from long experience!). However perhaps I just fit the figures by luck or I am just very average but from what he said and the fact it tallied with my results, I would suggest most peoples’ basal dose should be around 1/3 (?or less) than your total dose per day. However against this I see figures from other people on this site that are very different. and for example you appear to take 20u total per day, 17 basal and 3 units (1 for every 10g carb at 30g carb per day) bolus so your basal is almost the opposite of mine (almost all your daily dose is basal as opposed to a third). Given that other figures i see on this site are also different again, it just reflects what was said above that everyone is different! If you wanted to check your basal more, you could check your basal dose effects by using the fasting technique described above (and in Dr B’s book) if you wanted to (but if you already have something that works well for you definitely don’t change it and it just confirms that everyone is different and YMMV (your milage may vary!)). Still there are my thoughts on possible basal doses based on an N=1 experiment and a podcast of Dr B!
Best wishes
Ralph
Thanks Ralph, I think my basel rates are too high, having read Dr B’s tome and everything else I can get my hands on since the dreadful T1 diagnosis just before Christmas. I think once the low-carb approach starts to kick in I may well be able to bring that down. I wonder what you eat for your up to 30g carbs a day; I’m finding this diet boring and wondering how it’s going to be sustainable for ever. How long have you been diabetic? How was the decision made to split your basel dose? I’m wondering about this too. No one helping me to manage my diabetes is too keen on the low-carb approach so I’m grateful to have your input.
Hi Rache
i have been having low carb for around a year and a bit. If you look up my previous answers I have previously put a big answer describing what i eat but it is basically 5 bits of bacon plus 2 -3 eggs and mushrooms for breakfast (or equivalent as omlette), steak / beef (cold) and salad for lunch (I take it to work covered in salad dressing) and more meat (say lamb or beef) or fish - tuna salmon etc with green vegs covered in hollandaise sauce. When I started I used a load of artificial sweetener (either cake (max 4-5 carbs per piece) from Atkins cookbook or almond Quest bars (try microwaving them!) and loads of sugar free jelly with double cream (as Dr B suggests)) but slowly lost craving for those and started avoiding them. Now have gone for cold breakfasts also (canned mackerel in tomato sauce, 2 hard boiled eggs slices of cold cuts / salami and mixed cheese (Manchego / Emmental etc as well as cheddar…). It is a bit boring but then having cereal every day is not variety! I think cereal may be a bit addictive as it turns into sugar so cereal is possibly more “interesting” than omlettes/bacon etc but in fact so far I have got used to it and don’t miss the change. Luckily I like various roast meat / fish / barbeques etc and i think the Atkins cookbook has some good things in. I tried all the alternative breads from those books (or the Eades cookbook or the internet) but found tho some were OK substitutes, nothing really tasted that good and just reminded me what I was missing so have now managed to give these up altogether. Trouble with the diet is that you don’t necessarily feel ill just cos your glucose is high and it is hard to keep eye on what may happen in the future so there is possibly less drive to follow it. However for me not shooting up and down (getting off the roller coaster!) makes it so worthwhile it just reinforces the diet for me at present. Also I have a contin glucose monitor (see flatlines posts also!) and trying to keep that flat acts as a constant persuasion to stick to the diet (I hope it is really a way of life rather than diet but we shall see! - I don’t know that tomorrow I am not going to run into a cake shop and eat 3 buns before they can catch me! but I am gettting more used to it). In total I find I feel much better for it so am manging so far… As I mentioned above things keep evolving so, as this sort of diet leaves you much less hngry I often now only have 2 meals per day as in my original answer. Best of luck, R
PS Two more points: One is that i think that having a “treat” of carbs often “addicts” you to them again and then you have to withdraw allover again so avoiding any bread / cakes makes it easier (I am not sure if carbs are truely addictive or not but it is terminology used in many posts and certinaly I find if I slipped and had a bit of bread and a bigger dose of insulin, the urge to break the low carb eating was much stronger the next few meals… ).Re splitting Levemir dose that you ask: When I low carbed my basal dose went down from around 18-20 / day to 6 units and it was when i changed to low carb, found my low requirement on it, that I then split the dose - again as suggested by Dr B who said that low doses would not last the 24hrs which appears right. I have also tried taking another 2 units at around 4 a.m. which stops the dawn phenomenon 4 or so hours later - again as he suggested it would (in a podcast I think rather than the book). Fantastic to be able to stop this but so far don’t feel like i will wake at 4 a.m. just to do that! (If I later want to address that I will either use a pump or stick to my 2u rapid immediately on waking…). Best wishes
Ah Ralph, thanks so much for your reply and well done you for doing the low-carbs for so long. It’s great to get such a positive account particularly as I’m running to a fair bit of resistance from both my healthcare people and some family and friends. Still, I feel sure this is the best appraoch and I don’t want to miss one second of what’s due to me by getting an avoidable long-term complication. Maybe we’ll both change our minds at a later date, but for now I’m going to do as much as possible to make this work for me. Experimental cookery and a lot of yoga seem to be doing the trick at present. Here’s a question though - do you factor in protein a la Dr B when calculating your bolus doses? That’s my next project. How long have you had D? How old are you? I’m greedy for facts about other T1s as I don’t know any!
Hi Rache,Yep, protein calculated as per Dr B (a pack of cards sized peice of protein on your plate approx equal to 3 ounces (or 18 grams of actual protein if you work in those units) and needs 2 units slow (human) insulin).
I got T1 really late – an autoimmune disease in my 40’s just under a couple of yrs ago. First followed standard complex carb/low fat advice and struggled with the roller coaster. Soon found Dr B and tried it. Saw massive improvement with glucose levels and much smaller doses of insulin as I described before, so, whatever others said about it not working / being dangerous, I did not believe them cos I had visible proof this worked! Because of what people told me, I was worried about heart disease as eating all cream, butter and meat etc but have read about it a fair bit (and am medical anyhow which helps) and feel that the fat hypothesis is probably mainly wrong / based on a false premise from excess triglycerides causing the problem which themselves (even tho they are fats) come from excess carb intake (like feeding geese carbs gives a fatty liver or foi gras pate). To confirm this, as Dr B says in his book, my cholesterol actually fell (5.5 to 4.4) with a massive improvement in chol ratio to less than 3 on his diet with 2-4 eggs / day and all that butter etc. My HbA1c also stays around 5 – 5.2 rather than the 11.5 it was originally so again support for Dr B from my lab work. I therefore feel presently that this is the right way to go! I was also told that this was a crazy approach and that it was impossible to survive without eating carbs. Again probably wrong. Protein converts to carb slowly by gluconeogenesis (slow enough your insulin can keep up with it unlike eating carbs) and Eskimos and humans before agriculture have lived millions of years without significant carbs (i.e. may well have followed a very similar diet to Dr B) yet could still exercise etc… When they tell you you can’t exercise / survive on this diet, think of that!
Basically I can believe your healthcare team etc may be against this approach - many medics I have met are (tho they have never had to question or test what they have been taught – a lot of which Dr B shows to be wrong) but just show them your meter after a low carb meal and after a standard carb snack – there is no doubt which one is better for glucose control and also clear that poor glucose control causes complications which unfortunately diabetics get (rather than those giving advice!!). Also test lots and change things if needed (I test around 12 times a day(!!) less now I have a contin glucose meter but still quite often to check/calibrate it). Again testing (and lab work) usually indicate how you are doing and which approach gives better results.
I think it may take a while to adapt to a full low carb diet (perhaps as long as 2-3 months for your enzyme levels to fully alter to burning more fat depending how tightly you follow the diet) during some of which time you may feel weaker. I also think that it is important to keep salt levels up as you need some salt intake (albeit much less than most people have now) but just eating meat/green veg and eggs etc supplies hardly any salt (as it is usually in bread / processed food which you don’t get on this way of eating) so your levels may fall. If so, you may feel weaker, faint on standing up too fast or get night cramps. If this happens try salty drinks (stock etc) or just add salt to your scrambled eggs / omelettes etc. Also get lots of sleep (one night of short sleep can apparently double insulin resistance next day which you don’t want even with T1). Finally add exercise (lots of gentle stuff like longer walks with occasional shorter heavier stuff (weights/sprints) apparently better than lots of long cardio/endurance which can raise cortisol levels which are again not helpful).
You will find lots of support for this type of approach here and at Br B’s website. Dr B does regular podcasts (1 per month which you can download the next morning and listen to – see his webpage). Also check out http://www.phlaunt.com/diabetes/ a really helpful site when I first started, see http://www.thelivinlowcarbshow.com/shownotes/ and google Paleo diet / Robb Wolf for more info on this sort of approach. All these site were so helpful to me, it is great there are people out there posting this sort of helpful info and as ever Dr B’s book – what a brilliant piece of work!
As I say dunno how long I can keep it up but whilst it seems to be doing me good and improving my figures it acts as further encouragement to continue. There is a great delight in feeling you have some control over your numbers which so helps! Best wishes!
Has anyone read the PH Miracle for Diabetes? I wrote a page in the book on my experience using that diet. It was the best control of my life and I lost 20 lbs. I was so afraid to not have the carbs in my diet at first I added too much olive oil to my salads and started gaining weight. That convinced me that I would not starve to death on a low carb diet. When I visited my father just before he died I started paying less attention, then lost momentum and eventually stopped. I still am trying to get back on, but I have a weakness for doughnuts…
Hello! I have some basal questions as well. I started DR.B in December of 2011 so it's been a little over 1 year for me. I love it!! I had no problem adjusting to the 30 carbs per day, and basically eating protein, veggies, some seeds all in fairly smaller portions than I used to eat. I have been using Levemir and have been taking after breakfast about 8units and 7units after dinner. I then seem to wake up every 2-4 hours at night and check my blood sugar and sometimes end up taking 1-5 units Humalog, depending what the meter says. I usually can keep my sugar in the 100-120 range till I eat breakfast. Usually two eggs with one pat of butter and a couple cups of coffee with cream. Two hours after breakfast my blood sugar is anywhere between 160-200 so I take some more Humalog. When I eat lunch, I take my Humalog about 1 unit and two hours later will take anywhere from 0-4 units depending on what my meter says. And the cycle continuous throught the day/night. I test like crazy! 12-17 times in 24 hours. I did take my insulin before meals like DR.B says early on this diet, but had a super terrible low that scared the hell out of me. Now, I take my insulin both fast and slow after I eat. Not sure how to bring my insulin usage down, and not sure how to correct properly. Does any body else take their insulin after meals with success?
Thanks for any and all help!
Sorry no one has commented so far, but I think most here would agree that a 2 hour post-meal BG between 160-200 is too high. Most shoot for a two-hour postmeal below 140, while some would say shooting for a BG below 100, putting you in a "normal" range is ideal.
Since you are eating low-carb, and check often, take a look at your 30 minute and 1 hour post-meal numbers. You might be seeing a rise from protein conversion to glucose. On a pump, I'd program in a dual wave, or extended bolus, to take care of something like that. On MDI, splitting your meal bolus to take the late rise into account would be fine.
Whether or not a pre-meal bolus is necessary depends on what your numbers look like. If you are seeing good numbers up to 2 hours postmeal when you find yourself up into the 160-200 range, then I don't see an issue.
Good luck!!
Hi Yolande
Difficult to say what is happening - I am not sure why your blood sugar goes so high after breakfast of just 2 eggs butter and coffee. First thought is whether it is the cream?? (usually not but just check the pack to see how much carb per 100 ml it contains then measure out how much you add to a cup (pour it into a millilitre measure first) so you know exactly how millilitres and hence how many carbs you are taking in 2 cups - it may be more than you think(???). If this check only shows a very small number of carbs, then you are as you say eating a very low carb breakfast (as 2 egggs and butter should only have 1-2g carb and this is too small volume for Chinese restaurant effect to be affecting you) so next thought is this rise you mention could be "Dawn phenomenon" (which is in the morning the liver dumps out a load of glycogen to get you going and at the same time mops up insulin as per Dr B's book; so after getting up, many people have a rise in blood sugar). To address this you may need to take a small amount of insulin immediately on waking (Dr B takes 1.5U I think he said (could be wrong but anyway I take 2U apidra immediately on waking for this reason). To find out what to take to address dawn phenomenon, one morning when you get up, test your blood sugar every 30 mins for 3-4 hours (don't eat, just have water) and see if you go shooting up and if so to what level. If you do go up, you can work out what dose (by knowing how much 1 unit of insulin lowers your blood sugar as per Dr B's book) is needed each morning to correct this dawn phenomenon. A final thought is perhaps it is the coffee causing your morning rise - I have heard some people say that coffee raises their blood sugar. I think this less likely but test by having the same breakfast but with a different hot drink (green or fruit tea (hence no cream needed either) or sparkling water etc etc just to see if this addresses it.
In terms of sorting out your basal dose, again follow Dr B (or as described in thread above). Basically when stable and not having eaten for a few hours (usually therefore in the morning), take basal dose insulin as usual and miss breakfast (eat nothing just drink water if needed) for a few hours testing every hour. If you stay stable you have the right basal dose. if your blood sugar falls over the hours, your dose is too high, if you slowly rise in blood sugar over the day, then your dose is too low. etc.
It is hard to address all this at once and there are lots of ways to do it! I suggest first assess how much 1 unit of insulin drops your blood sugar and how much 1 gram of glucose raises your blood sugar / how many carbs 1 unit of insulin covers for you (to do this, read Dr B's book - not the whole thing! just check the pages that tell you how to do this which is quite short). Once you have an idea of how much carb you can cover with insulin, sort out why your sugar goes so high after a low carb breakfast - have the usual breakfast but omiting coffee and cream. If your sugar still goes up despite having only 2 eggs, butter and clear fluid then likely cause for rise is the dawn phenomenon - if so, one morning, miss breakfast and test to see how high it goes / how much you have to take to correct it. Once you have dawn phenomenon sorted (by taking for example 1-2 units immediately on waking (or whatever you testing tells you is the right dose for you)) you can then test your basal dose as above. Once basal sorted you can test 1 and 2 hours after each meal as suggested above and take insulin to control these figures again as per Dr B / your dose schedule. If you have the right doses you should be able to take insulin when you start eating. I am sorry to hear you had a hypo which sounds very scarey but it should not be becasue you took insulin before meals. (It may be that you took it too early before a meal or it may be your dose was too big that gave you a hypo but if you take (a correct) dose when you actually start eating, you shoudl be fine (and this is much safer than letting you sigar go high then taking insulin a few hours later to chase it back down).
Sorry for such a long answer but a lot to describe! Summarising the above: having 2 eggs, butter and clear fluid breakfast one day and testing afterwards for 2-4 hours will sort out whether your high sugars are from coffee / cream or dawn phenomenon. Knowing your insuin to carb ratio as per Dr B's book (only need to read a couple of pages that describe how to do that) will help you find dose of insulin to correct dawn phenomenon (if you have one) each morning. once that sorted, you can check basal dose, then check 1 and 2 hours after meals to work out dose of humalog you should take when you start eating (you may do this bit before checking basals?). Good luck with it!! regards, Ralph
I have been eating low-car Dr. Bernstein's way for about 8 years. I have loosened up my eating a few times and found that my control just got worse. Now I am convinced that going very strict is the best approach. I think Ralph is right on everything he has mentioned. I have read and re-read Dr. Bernstein's book, and I have also availed myself of many of the great resources found in the Paleo/Primal world.
On basal insulin... it does depend on the person, but, if we are all ideally healthy we will use an approximate amount of insulin for our body weight. As Ralph mentioned, lack of sleep can cause insulin resistance, and so can many other lifestyle factors. Even in non-diabetics, people who live a less healthy lifestyle are producing more insulin to meet higher demands. Reducing insulin resistance is always a good thing. Whenever I make positive changes in my health regimen I get confirmation by seeing lower insulin numbers and lower glucose numbers. They travel together, and when they both go down together,it's good change.
I use a pump and my current basal dose is 17 units of Novolog. I have seen it come down from up to 35 units a day down to my current level. My ratio of basal to bolus is still not what has been described by Dr. Bernstein and others on this thread. I am seeing my basal:bolus ratio at about 7:3. I will be looking at seeing if a reduction is needed, but it has been working well for me. I have found that eating a ketogenic diet has created a need for more basal and less bolus overall.
I found Dr. Bernstein pretty soon after being diagnosed in 2004. Low carb is the only way to consistently stay relatively flat. I completely agree with his law of small numbers. He might say that caffeine will not raise your BG but it does for me - sometimes up to 60 points. I bolus even for black coffee if I am anywhere above 100 in the morning. Just shy of one unit.