Just curious, if so inclined, how much daily basal do you all use, either on MDI or pump? If on MDI, lantus or levemir, 1 or 2 shots? On MDI, do you find your basal shots last throughout the day/night or are you constantly giving yourself corrections? How many shots total in a day? Do you have DP, if so...how do you manage this on levemir or lantus?
THANKS much! :)
I'm currently using 11.73 on my pump.
Rule of thumb: Basal runs roughly 50%+ of total daily insulin. This rule is more exacting for T1s... T2s on insulin, with some beta cell function, can play with this a bit more.
In the end, though, the only true way to dial this in is to do some basal testing during fasting. This sort of testing should be performed for various times of day to determine different basal requirements. Most people find 3 or so periods to work -- dawn/wakeup, mid-day, post-dinner.
As a T2 basals are an interesting phenom for me. I can go from 0U up to 1.25U without changing my BG behavior (stays flat). I interpret this to mean that with my insulin resistance, I need a basal of around 1.25U, and my pancreas can keep up with that. To give it rest, I run a 1U basal normally.
Dave, the 50/50 "rule" is actually only a starting guideline. I typically took double the basal as a well controlled T1 - even when I was on nph. My typical basal pumping was 14 u/day
I take 8 units levmir at 3pm and 3 units at 2am.. I have recently changed the times due to dls and wanting to go to sleep earlier. I do have dp, but not all the time.. this was why I started splitting my dose. My bg almost always follow no pattern for very long. I almost always spike around 1-2 hrs before my next basal dose or closer to the dose or after, if I haven't eaten a meal and had some fast acting… even then sometimes. I had to lower my am basal recently due to waking up low, I also now have a snack before going to sleep again. Something that was recommended by one of my nurses in the hospital. If I lower my basal too much I immediately start spiking a lot am. Sometimes by even one unit. What I do now is check around the time for basals and add a unit fast acting and water/exercise if possible to prevent the spike also. After my nighttime basal, if I'm out shopping etc. I almost always go low, but not always so I will have pieces of candy/nuts etc. when I feel low then.
I'm not sure how much novolog I take now, I would have to look at it and guestimate from my phone, but I gave up on the ratios of basal to fast acting because they didn't fit my needs. Overall I have backed off corrections somewhat due to lows, but I still have lows, lol.
thanks all! keep them coming, please. it's very interesting to see what other's use in terms of management. also, thought I'd attach latest news letter from Gary Scheiner, interesting topic regarding larger vs. smaller shots (imagine it's the same with pump??) and absorption rates also info on AP and new medtronic pump with new sensor info.
1272-DiabetesBites2013November.pdf (1.95 MB)true...i use more basal then bolus probably because i low carb too. crap, there are no rules to this stuff half the time..ugh!
thanks, 'meee'. yeah i too go high when my next basal shot is approaching (on levemir). i too seem to have to take a lot of shots on MDI, can never get it right, it seems. 1 unit > or < can make a big difference for me too. I keep wanting to do the pump, have had such problems there too. I'm rethinking and trying to figure out what I should do..ugh!
yw :)seems like we have similar problems Sarah, hopefully we will work it out better soon. my endo keeps saying pump, but there are so many reasons not to for me and my father is sure it will overdose me or land me back in dka etc. something I never want to go through again, ever!
yeah, i hear ya. i like just being able to shoot the insulin and know it's in there, ya know...and not worry about sites, etc...but then one can't really adjust to individual needs with basal shots. last attempt on pump, i stayed at over 200 for nearly 3 days corrections, corrections, increasing basal to .50, nothing - couldn't get them down (and had changed my pod, too). I felt horrible. time before I kept going low, low, low. Makes no sense to me. I can't seem to figure this out. I totally understand your fears (your father's too) of DKA, I too never want to go back there..so awful, ugh!
i do 3 units of levemir at 9.30am and another 7 units at 8.30pm. i was doing the pm shot later, at like 11, but was waking up high. Brian (bsc)suggested i try changing the time and it works much better now.
i dont bolus for most of the time, as i low carb and do lots of exercise. sometimes i have to correct but thats from eating things, not from insufficient basal. on thanksgiving i will be bolusing like its my job.
I use about 11.3u basal in my pump. When I was on MDI I used 11u Lantus split into 5u am between 8am & 9am & 6u Lantus pm at about 8pm.
Dave, the 50/50 "rule" is actually only a starting guideline.That's why it's a rule of thumb.
If it were more rigorous it would be a "rule of big toe".
wow, those are weird times. do you get up in the middle of the night to inject?
i think the more tan double dose in the evening gets rid of dp?
My basal profile looks like this:
12:00A - 0.90u
03:00A - 1.55u
10:00A - 1.10u
04:00P - 1.25u
09:00P - 0.90u
When I was on Lantus, I did two shots a day as it did not last 24 hours for me and I ended up with extreme highs around dinner when I only took one shot at 10:00 PM. The only way to cover my DP was to get up at 3:00 every night and take two or three units of Humalog, and I also had to bolus extra at breakfast. For me, the variability in my basal rate is the number one advantage of the pump. The second advantage is that, with my hormonal cycle, my basal can rise or fall by 0.15 - 0.20u an hour in a matter of 24 hours (and my ISF and I:C ratio change in similar proportions), which was literally impossible to keep up with on Lantus.
Wow reading what everyone else has mine seems sooo much! I inject levemir once a day and have 19 units! Type1 for 4 and a half years
niccic, some of these folks are honeymooning and still producing insulin. don't worry about it. my endo told me most of his T1's out of honeymoon are pretty close to at least 20 u on MDI.
thanks, jen. yes...this is what's happening to me, a shot at 3am and then a ton of novolog at breakfast (I hit nearly 170 - 180 every morning at 9AM, if I've eaten or not), numbers just rise the minute i wake up too. main reason i'm still aiming for the pump.
I was worried about you during that period when you were constantly high too… I didn't know that you were having low problems too, and those are dangerous, seriously I just recently watched someone's videot at youtube about a terrible low she had overnight- she is very lucky to be alive for sure. I think that if you can ever work it out on a pump and you're happy it would be great because of the basal adjustments- I would really like that too, but otherwise just stick with mdi and maybe we can refine it improve it with different insulins eventually and other techniques etc. It could be that you due to various things have more trouble absorbing the insulin that way and people do get scar tissue eventually sometimes too and have to stop.
And yes, NO MORE DKA please god!!! I am very lucky I lived through everything that happened to me :)