Thinking About Basal

Type 2
1

Brief background: I am a long time T2 who started insulin last year (at my request, not doctor's advice). It's given me a degree of control far beyond anything I was able to achieve before. Wish I'd done it years ago.

I have just enough beta cell function remaining to keep my BG below 100 when fasting, most of the time. But I can't tolerate food at all -- so, I bolus for meals with fast acting insulin. I'm delighted with the results; my current A1c is the best it has ever been since dx, so the trend is certainly headed the right way. But . . . after nearly a year of this, I know that the SD still isn't where I want it. So I'm thinking that a small amount of Levemir might help flatten the line even further.

Comments and thoughts are actively invited.

2

Hi, I am using Levemir but I do not have anything left on my pancreas so I have to do it, it is better than lantus for me, I believe, you can do that to help your pancreas to relax a little and at the mean time you could get to 85 or so fasting

3

Adding basal can't hurt. The way I look at it is that by easing the basal workload done by you pancreas it might help preserve your natural insulin production. It might also help your pancreas build some insulin stores to be used for the first wave response when carbs are ingested.

4

Thanks for the comment, Gary. I'm inclined to see it the same way.

5

Hi David!

Once your body has lost a certain percentage of your beta cells, you need a basal insulin like Levemir or Lantus, to get and keep your baseline numbers within healthy ranges.

How much you might need is something you can only find out by starting it. They usually start you on a low dose such as 5 or 10 units. Levemir needs to be injected twice a day. Lantus is supposed to be a one daily injection, but some people need it twice a day.

The basal and mealtime insulins are meant to work together, and using them together gives the best control. Other than growing new beta cells, or using a pump, you really can't do better. (We don't know how to grow new beta cells, and you're certainly nowhere near needing a pump yet!)

6

Hi Emmy, and thanks for the reply.

I do have significant beta cell function left (c-pep says so, and so do my daily numbers), which after 20 years of this is nothing to sneeze at. But it's nowhere near enough to deal with meal spikes. That's why my initial focus was on bolusing for food and learning how to do it accurately. Basal insulin has always been in the back of my mind, but my strategy with diabetes is to change one thing at a time and take small steps.

My A1c is in the mid fives and dropping, so I know that what I am doing is working. But my SD is not where I would like it to be, and I think it's about time to find out whether a small basal dose can flatten the curve even further. My hunch is that it will.

As for pumps . . . oh my. That's a very long rant that I won't take up this space with. Suffice it to say I'm not a fan of them.

Thanks again for your thoughtful comments.

David

7

Oh David I love my pump. It has truly been easier for me than MDI. Everyone's D is different, I have a TDD of around 50 units, pumping for me has been wonderful.

With the lower TDD that you have I can see how a pump would be of little value to you.

8

Not a fan of pumps either! Taking it one step at a time is definitely the way to go with insulin, otherwise you don't know which one needs adjusting.

Sounds like you know what to do :)

9

Congratulations on your success. I am trying to work with the problem I have with food. One gram of carbs raises my bs 10 mg/dl, so the typical ADA meal of 45 grams sends me skyrocketing. It blasts right through the humalog. I now am limiting carbs to 15 grams per meal and as long as I eat an equal amount of protein I can stay a bit level when I take the bolus of 4 units of Humalog. Still trying to work it out though. Since you have got it in line do you have any advice?

10

Wow -- and I thought I was sensitive to carbs. One carb only raises me about 5 pts, ordinarily.

If you haven't done so already, read this:

Richard K. Bernstein, Dr. Bernstein's Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)

Bernstein is a controversial figure in the diabetes community. He is one of the true pioneers when it comes to management and control, but his approach is too strict for some people. That's okay -- the correct way to approach any expert's advice is to take what's useful and leave the rest. He does know the field, though -- I've gotten more day-in day-out practical knowledge from him than anyone else. The introductory chapter explaining what diabetes is and how it works is worth the price of the book by itself, IMOP.

One thing about Bernstein: he is a strong proponent of a low carb diet. He doesn't have much use for the ADA guidelines. In this I agree with him.

The best advice I can offer is this:

1. We are, each of us, highly individual in our responses to food, medication, etc. What works perfectly for me may be completely ineffective for the next person. Guidelines, no matter whose they are, are only starting points. You need to determine the regime that produces good results for you, and the only way to find that out is by trying things and testing to find out what works.

2. Test, test, test. All the theory in the world can't equal real measurements of what's actually happening.

3. Take small steps. Don't try to conquer it overnight. It takes time to get good at this -- and you will.

4. Test, test, test.

5. This one is really important: when you make changes, change only one thing at a time. Otherwise you can't know which change actually caused the result you got. If you're tweaking your diet, don't change meds at the same time. And vice versa. Etc.

6. Test, test, test.

7. A couple more excellent books chock full of very useful info and helpful tips:

Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)

John Walsh et al., Using Insulin (San Diego: Torrey Pines Press, 2003)

The Walsh book is a little bit dated but still fundamentally sound and loaded with good information.

8. Test, test . . . . you get the idea.

9. Stay connected and active in tuD. This community is an incredibly rich source of shared experience and moral support. I've found nothing else remotely like it. For some, it has been a (literal) lifesaver.

.

Hmmm. Didn't mean to ramble on quite so much . . . but you did ask for advice -- LOL. The above is essentially what I've done, and it's working. But I'm still improving. There is always more to learn; after all, we're going to be at this for a long time. ;-)

Hope some of this is helpful!

David

11

Hi Deb, I wish I had posted sooner to your reply. You say that your carbs blast right thru the Humalog, I wonder if you are not taking your insulin far enough in advance. If you are not doing it might be a good idea to inject 30 minutes or more in advance. You might also consider switching insulin to Apidra which has a more rapid start of action.