As Terry confirmed, bolus insulin is for meals, but it isn’t JUST for that. It’s for any upward spike that isn’t otherwise controlled. The common term for that is “correction”. If your blood sugar takes an unacceptable upward leap, you use a bolus to correct it, i.e., get it back down where it belongs.
Also mentioned, self education is important to understand what is really going on and how to deal with it. There are some good books out there that deal with these topics in detail. Here are two of the very best:
Gary Scheiner, Think Like A Pancreas (Boston: Da Capo Press, 2011)
Richard K. Bernstein, Dr. Bernstein’s Diabetes Solution, 4th. ed. (New York: Little, Brown and Company, 2011)
Darn Phenomenon (DP) happens when your body increases hormones like cortisol and adrenaline to help you wake. It often starts around 3 am. If you are non-diabetic then your body will naturally produce insulin to offset the blood sugar rise that these hormones cause. But things don’t work that well with us. I’ve struggled all along with DP. Right now with Tresiba I have the best control I have ever had. I don’t have that rise at 3am. I do however have a rise that starts right after I get out of bed, so I usually will take a few units to offset that rise. And sometimes, your blood sugar will just randomly do “whatever.” Last night I went to bed at 100 mg/dl and for some reason it went up to 180 mg/dl at around 1 am. Go figure. Without a bolus insulin you don’t really have the proper tool to bring down a high blood sugar.
220 when I went to bed (after a 5-hour period of no food/medication from 5 pm - 11 pm ) and 165 when I woke up. 55 point difference. So does that mean I still need to increase the basal Tresiba by one point adjustment up in two more days if no change? I went to 20 units yesterday and know I need to wait at least 3 days to up the Tresiba.
I am thinking of going to 21 units in two more days if same span of numbers the next two mornings. Thanks
You can’t do a basal test if you go to bed with a blood sugar of 220 mg/dl. You need your blood sugar normalized, ideally 70-120 mg/dl. And you dropped 55 mg/dl overnight. That suggests that your basal is actually too high. With a properly set basal you should awake +/- 30 mg/dl of your blood sugar from when you went to sleep.
You might try to red the test with more extended fasting, perhaps skipping dinner to allow your blood sugar to return to normal levels before bed.
In truth it may just not be possible to do a proper basal test if you are requiring substantial parts of your basal dose to cover your meals.
ok thanks i will see how numbers are this week and am seeing the endo on Jan 12 so will discuss with him then as well.
if a meal is less than 15 grams of carbs, I thought you did not need a bolus. at least my bg is more in the 100-200 range and not 300-400 range with the insulin. i am very concerned about going to low. if my bg is 200 at night and i take a bolus of whatever that should be 1-2 units? then do I risk going low at night. This is the scary part for me.
The specific amount of carbohydrate is not the determining factor. Your body’s response is. Simply put, you need a bolus if whatever you ate causes your BG to rise unacceptably high. That will be potentially different for each individual, for each meal, for each set of circumstances (environment, illness, stress, etc.). There is no specific rule that says “this much carbohydrate is safe and this much isn’t”. Managing diabetes is an empirical process, unfortunately not susceptible to fixed, unchanging rules. (Sure would be nice if it were, but . . .) Your BG reading (i.e., your meter) will tell you whether a bolus is needed, or not.
And as others have indicated, until your basal is set correctly, it’s an exercise in futility to try and achieve a good balance with any other insulin. That will usually end up with you going in circles chasing a constantly moving target.
Yes, correcting at night can be tricky and there are risks of going low, but if you’re actually bolusing for meals during the day, the hope is that you are more stable throughout the day and wouldn’t be at 200 right before bed. Ultimately, it’s about working with your diabetes care team (if you have one, I didn’t) to figure out your insulin to carb ratios and correction factor. For example, I take a very small amount of basal, but require quite a bit of insulin per carb for someone my size. Also, my correction factor shows I’m insulin sensitive. My insulin to carb ratio averages one unit per eight grams of carb (1:8), but when I’m correcting, one unit of insulin brings my BG down 100 points, so my correction ratio is 1:100.
You’re a long way from going low at this point and as more tools are brought into play the range of your swings will be smaller and your risk levels will reduce even as your blood sugar is kept in lower ranges (and hopefully your comfort level with normal controlled blood sugars increases simultaneously).
Reality is some low blood sugars are generally a fact of life if using insulin… it’s not a big deal you know when you might be at higher risk and you’ll test and if necessary you’ll head them off in advance by eating some candy and go on with your day-- could be worse
OK I have given in to Novolog for mealtime insulin. I started yesterday. I am reducing Tresiba to 16 units per day and taking some units of Novolog with 30 grams of carbs for meals. Nurse said I was starving myself with only 15 grams of carbs per meal and so I am trying a bit more carbs like 30 grams per meal. I hope this works. Went to yoga and bg was 101 afterwards…hope everyone has a Happy New Year and thanks for all the great input on Tresiba!
I had a small snack prior to yoga think it was a yogurt 11 g carbs. No insulin. This morning my fasting was 165m but I forgot to take the metformin at bedtime 1500 mg. So this morning I took 16 units of Tresiba and 3 units of Novolog with breakfast. Plain yogurt about a cup, blackberries, pecans, 1/2 banana. I figured this was about 30 g carbs. I am testing my sugar in an hour to see what it is 2-hours post breakfast. Quite the learning process here. Today we are doing yoga again at 1030 am. The yoga makes a huge difference, really any vigorous exercise but I think something with the stretching of the muscles, inversions and such really stimulates the blood flow and helps metabolism and circulation.
As far your Basel is concerned will be your A1C level if you are high I would increase the Basel with all this insulin that’s available in your body, carbs will be a problem.
Your weight is all about Carbs that you eat. Do you Exercise? If you don’t then I can see just gaining more weight.
They say, you are what you eat!!
