Help with setting basal, please - revised!

“…trying to keep the two doses exactly 12 hours apart.”

Jean,

I don’t know if anyone has responded to this part yet, but, my split Lantus is not 12 hours apart. When I split for 2 doses, one is at 0800 or so, the second one is at 2200. When I split to three doses (winter months), it is about 8 hours apart. I set my cell phone alarm for the 2200 dose.

Trisha

No. Basal insulin is just meant to cover the glucose put out by your liver. If you start high, don’t eat and stay within 30 points then your basal is doing what it should.

If your total daily dose is more or less correct but the balance between bolus and basal is off, then you will probably spike after meals and then your basal will slowly correct the number down. This can work but it isn’t optimal. You want to use your rapid insulin to control your meals and to correct errors for two reasons. First, it’s quicker and less likely to take you low later on and second, the math is simpler. If your basal keeps you flat all your carb and correction calculations are single variable linear equations (with cheats of course).

Maurie
Maurie

Yep- You use the Basal to “help” Keep the BG’s down, not to bring them down…
Whatever your BG is at the time you take it? and you took the correct amt. of Basal? It “should” maintain at that same level…+/- 20 to 30 pts they say…

I take my Basal to Get what my BG’s are At bedtime… striving for 100 BG 's at bedtime and if Not at that level? I have to take A CB or Correction Bolus of Fast acting- Novalog to treat that AND take my usual Basal-Levemire Insulin … 2 shots…

You CAN use Lantus to Bring sguars down by taking more than you would use for your Standard Basal, since it does have a Peak time… I used to get hypo’s using it all the time, regardless of what method I used or if I took less, my BG’s Went UP over nite…50% of the time…

Leveimire was great after getting it, no more over nite Hypo’s… but then again, I went higher in the AM about 50% of the time…

So since I can’t get a Pump? I set my alarm every nite for 3 hrs, wake up and if have too? take a CB… Isn’t that nice? but since I usually get up 3- hrs later ( only sleep 6 hrs on ave) that CB covers any extra Sugar and I’m fine and dandy by the AM…

#1 suspect? Dawn Phenom they call it… your liver puts out extra sugar a couple of2-3 hours before you get up, to have the added energy to get up bright and perky… and about the only thing that can fight that? A Insulin Pump set to Increase your Basal about 2 -3hrs before you get up… and seeing as your not as active sleeping and thus if your Liver doesn’t slow down putting out over nite? Your BG’s will keep going up over nite as well, some have to set their Pumps for More Basal a few hours after going to bed and even more a few hrs Before getting up…

So your 1 shot of your Lantus isn’t going to get that all done…

Once you do take the “right amt” that you get up with the same BG as you went to bed, say 3-4 nites straight? Then your pretty close to establishing your Correct Bedtime Basal…

If your Getting Up More than say 20 pts above what your went o bed with? Increase that Bedtime by +10%… and keep doing so, so you Get up within the same +/- 20pts of what it was at Bedtime…is about all you can do now…

If your too high at bedtime? You have to take a CB- Correction Bolus to get it down ( Humalog or Novalog) , so you have to ask your Dr. for getting that . And You can try using just the Lantus by taking 10-20% more in those situations too…

1 Tot. bedtime dose of Lantus as your Reg. Basal
2. 10-20% more if your say at or above 150 at bedtime.
3. and anytime you DO take Extra Lantus? You Should set our alram to 2-3 hrs later, have your meter at your bedside and some Glucose tabs handy and wake up and test, just to be sure your not going Too Low over nite…

and that does something else… Punishes you for not having Good BG’s By Bedtime…so maybe you will be more Focused in the future… and not have a Late Snack or Eat too many Carbs for Dinner, etc… You Bad Girl you…lol

3 lashes with a wet noodle…

See? Isn’t this Fun? Not so much is it…

and believe me! You Don’t want to be a T1… We have an Added little problem and taht is this Auto Immune disease that wants to play like Pac Man and eat up all our Organs and destroy them, weaken our Immunity to everything… from Colds to Virus’s to our everything else…

Oh, BTW? Don’t expect to get all this stuff over nite… it can take Months…Yes, Months… and just when you think you have it all figured out? It will have to be changed again, always tweaking it from time to time…

We gain weight- need more insulin we are getting older and slowing down and so is our metabolisum for burning up fat and sugar = need more insulin…and 1/2 dozen other reasons that this disease is Constant… Constantly changing…

Keep the faith… it will get easier to understand in due time…Being able to do something about it, is another question…

and YAH? If I had a CDE that said that? I’d get up and walk out and report him /her to get her fired…She’s an Idiot… lol and BTW? I have done that with both I’ve met over the yrs…

As with reporting on some Endo’s as well as being Incompetent treating Insulin T1’s… or AID…Adult Insulin Diabetics… But those Hospitals need anykind of Endo and are desperate to get them and keep them… so they will ignore your complaints and try to make you be the bad guy… to avoid a lawsuit…

I think 9 out of 10 Endo’s are probably useless for us T1’s…as are most CDE’s…but seeing as we T1’s are a Minority , 1 out of 20 D’s they see at the most and most are lucky to have to deal with a handfull of us at the most and just deal with the T2’s giving out Pills and Telling them to just loose weight and collect their $… So it’s not their fault… Who else will tolerate us? Internist or PCP? Or OBGYN? LOL

out of 8 Endo’s I’ve met in the past 18 yrs? only 1 has read Those Boks we talk about and NONE CDE’s …! Isn’t that nice…?
And at the VA? I go in every 6mos and he always has 2-3 interns doing their 3 mos rotation to become Endo’s and I always ask them if they ever even Tested their Blood Sugars? Haven’t met any yet. I pull out my Insulin Pen and ask them if they ever used one of these? None have even seen one…
and most PUmpers I listen too? Get more Help and support from the Pump Rep. than the Nurses/Dr.'s…

What a Joke isn’t it?

and R U Setting your Bedtime alarm to get up in 3 hrs after going to bed? You should when starting out taking any over-nite insulin, so to ck that you won’t go Hypo ( too Low ) over nite…Better to be high than too low…
For like I said… that Lantus can cause Hypo’s…

No doubt about it – insulin resistance is the pits. But as you get the hang of the basal, which many people have explained very well, then you can go to work on the boluses. It takes time, and is an art rather than a science. Because you’re right about all the other stuff going on in the body that you have no control over. I think the basal is the most important thing to get straight first, though, because once your BGs are level fasting, then you can work on corrections, and on boluses with more confidence. And then be prepared to test and correct as often as you need to. Being on insulin is like juggling 4 balls at once – 3 balls are hard enough, but 4 are almost impossible (I’ve tried!)
Welcome to the circus!

Wow! Thanks, everybody. This actually makes sense to me now! I don’t know why I was having so much trouble:

Basal insulin is supposed to keep you sort of hovering wherever the last food/bolus put you.

If you’re drifting down five, six, seven (plus) hours after the last food/bolus (- 30 mg/dl) then the basal is too high.

If you’re drifting up five, six, seven (plus) hours after the last food/bolus (+ 30 mg/dl), then the basal is too low.

To use my new elevator analogy, the bolus is supposed to send your BG elevator to the right floor and the basal is supposed to keep your BG elevator holding at that floor until the next food/bolus.

I realize it will never be that exact, but at least I understand now what I’m aiming for. THANKS!!!

Yep, you should be correcting whenever you’re high. Goal is to keep BG as stable as possible. Remember to calculate how much insulin you’ve got on board so you don’t stack insulin & go low. In general, rapid acting peaks at around 2 hours & is gone in about 4 hours. Be careful correcting highs before bed. If I’m over target at bedtime, I use half the usual correction dose.

Like Maurie said, it really depends on where your starting point is and whether or not you still had some food in your system that could throw it off and any fast acting working. As long as all the food and fast acting insulin is gone, then you can just look at BS. If you start at 180 and end up at 280, then it would be the basal. If you start at 180 and end up at 200, then your basal is OK (unless you want to use John Walsh’s 15 point rise instead of Gary Scheiner’s 30 point rise).

Don’t say “never”! That’s a long time!!

Yes, thank you. Very helpful. This is a graph that I found helpful when trying to understand why setting a basal is so darn trial and error. It’s like trying to aim for a moving target, of course:


Wow. This shows EXACTLY why a pump is so necessary for some people. Lantus just will not work well if your body needs different amounts of basal insulin at different times of the day.

I was gonna add too that when I adjust things, the first day often looks worse (both directions, higher or lower or maybe higher Std Dev?) but then it seems to settle in. I can’t think of a logical reason for this but I would recommend being patient when exploring new ratios/ rates/ etc.?

I know, right?!? As I’m 54, I’m somewhere between the dark square and the dark triangle. Look at the range of basal requirements! It’s like a roller-coaster.



Weeeee!!!



Of course, everyone should be on a pump – unless they have super-human powers to turn on and off their absorption of Lantus at will. Not this gal. Nope.


Yes, thank you. I’m waiting five days or so between tweaks to the Lantus, just so I have a range of days to look at and make sure I’m not going hypo in the evening/night.

Of course, understanding what I’m looking for helps!!!

Now that I understand, I think my basal may be about right. When I look at extended periods without eating, the starting and ending values seem to be less than +/- 30 on most days/nights (i.e. it is holding me steady.)

I just need to get some middle-of-the-night readings to see what’s going on between dinner, 3 a.m. and 6 a.m. (while fasting after a 6 p.m. dinner.)

I’m also considering going back to breaking the Lantus in half, but keeping the injections closer than 12 hours apart. We switched my Lantus to morning because I was going hypo sometimes in the night, but I don’t think I’m getting 24 hours of coverage out of it. I’m about ready to bite the bullet and go to two shots instead of one, six hours apart.

I’ve been (usually) injecting 100% at 6 a.m. However, I think perhaps I should inject 40% at 6 a.m. and 60% at noon, to keep from going quite so high in the period between 3 a.m. and 6 a.m. when the previous day’s 6 a.m. shot is winding down.

If I do go too low due to variable absorption or variable insulin resistance, it will be easier to catch/treat while I’m fully awake than it was when I was getting these hypos in my sleep.

Then I can start playing with the bolus and corrections some more. Isn’t this…fun?

are you taking regular insulin Sounds like you need some regular to cover dinner and then a lil less long acting insulin

Thanks dickengel.

OK, here’s the next conundrum:



This is a revised graphic from G. Scheiner’s book, “How to Think Like a Pancreas”. Please note that I have removed the other age-groups and am focusing in on the “typical basal requirements” for 21 to 60 year olds.



In my revised graphic, I’ve added a simplified (i.e. perfectly level) pink line to denote where I might set my Lantus basal. I’m not on the pump so I don’t get to have an intentionally variable basal.



OK, here’s the big question: I understand that I can inject a correction upon rising at 6 a.m. (vertical turquoise line) to make up for the fact that I’m going to be too-high during the “yellow” period. But what do folks do about the period between, say, midnight and six a.m.? Do you give yourself a correction before you go to sleep and pray that you don’t go hypo in your sleep? (That is, count on the rise?) Do you set the alarm for 2 a.m. and test, and then correct (in the middle of the rise?)



Am I out of luck without a pump, and just have to accept that I may go hyper every night, but then again, I may not?



I have had a few middle-of-the-night hypos; that’s why we switched my Lantus injection to the a.m., but I still don’t understand if I’m supposed to just accept the middle-of-the-night rise (and subsequent tissue damage) as the price I have to pay for not going hypo in my sleep.



Thanks for any insight!!!


Yes but probably more like 4 or 5 hours for the bolus. To test, the recomendation is to skip a meal and then look at the 6 to 12 hour period and see if yo stay i=on the same floor. Once tha basal is right then the bolus can be tweeked!

Thanks, Lynne. It is confusing. As of this moment (!!!) I think we do have to set the basal for the times when we are (generally) the lowest (to prevent hypos in the afternoon/early evening) and then cover the higher morning times with a bolus/correction – but I still don’t know what to do about the period between two a.m. and six a.m.

Hang in there!

Jean, when I was on MDI I would split the long acting breakfast and dinner - the peaks would interact with each other and create more pof a straight line basal. Then I would use sliding scale 4 times a day Breakfast, Lunch , Dinner and Bedtime. So in the case you showed high at bedtime, yes a correction bolus could be used, generally bette with a small snack

Thanks! I hate the idea of adding yet another injection (mostly because I have a hard time remembering, with all the other junk I have to do) but everyone has been encouraging me to split my Lantus doses, so I guess I’ll just have to do it. (Insert whining here…)