Typo
SUCH as Tinsyl’s mom
Sorry!
Unless you are also insulin-resistant (in addition to not producing enough insulin because your mistaken autoimmune system views your beta cells as alien invaders 
that must die 
), I’m not sure why your endo wants you to continue taking Metformin. For one thing, it doesn’t appear to be as effective as you’d like in mitigating your post-prandial spikes. I realize that with LADA (or Type 1.5, as it’s also called) which is actually slow-onset Type 1, BGs can be controlled for varying periods of time with oral meds designed to combat insulin resistance. I’m wondering if this isn’t another of those “Insulin is the last resort and best to avoid needles at all costs” and whether your endo feels like s/he is “sparing” you having to inject more times per day…
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Generally the treatment evolves in the opposite direction… From once a day basal being sufficient to the more complicated MDI when and if it becomes necessary. I’ve not heard of anyone going from MDI to 1x daily basal only— the only situation in which I might imagine that happening is if in old age the patient was losing the mental ability to administer MDI safely and effectively
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Unless I’ve misunderstood something, Tinsel’s mom is not using a basal-only insulin regimen (Tresiba without a rapid-acting insulin). My understanding is that she is continuing to use a rapid-acting insulin (Humalog, if memory serves) for correcting and bolusing for carbs. Please correct me if I’m wrong.
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I think she’s asking why not just go from MDI to once a day tresiba only… Because that’s what’s been working for her
The answer being, because it kinda just doesn’t work that way…
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I think there’s still some confusion over terminology here. Your question (correct me if I’m misinterpreting it) seems to imply that you think MDI and basal insulin are the antithesis of one other. That’s completely wrong. MDI stands for “Multiple Daily Injections”. It doesn’t imply a particular type of insulin. The most common MDI regime involves the use of both types–basal (long acting) and bolus (short acting). A basal insulin is most often one—but only one—component of an MDI protocol.
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OK, I think I finally get it… 
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Yep yep to Sam’s take on what I was asking
Just too inexperienced to see that Tresiba can be a part of an MDI regimen.
Thanks to Tinsyl for letting me ask these questions.
Now I see what she is managing for her mom, and why the high 200s are causing her concern.
Thank you to Rose, Sam and David for helping me get there!!!
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If bolusing for snacks leads to hypos, then something is significantly wrong with the I:C ratio, ISF, and/or basal dose (if you account for any IOB from previous meals). Saying “Don’t bolus for snacks to avoid lows” is a cop-out (does anyone even use this term any more?) which, to me at least, has the following between-the-lines messages: “I am too lazy to teach you about determining accurate dosing variables or won’t take the time to steer you towards a good manual (such as Think Like a Pancreas).” or “I think you are too stupid to learn these things and I’m afraid you will kill your mother if you adjust things on your own.” But I’ll give your mom’s doctor the benefit of the doubt and try to believe that the bottom line is that s/he wants to keep your mother safe. However, IMO, too many doctors are so diligent about keeping their patients with D “safe” that they end up teaching their patients to be complacent about BGs that are too high for extended periods of time. They convey the message that low blood sugars are so dangerous that they should be avoided at all costs, even if one of those costs is maintaining less-than-adequate BG control that leads to shortened lives fraught with complications…
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I’ve encountered that “don’t bolus for snacks” mantra elsewhere and it just makes no sense. In the first place, “snack” is a subjective and imprecise term. One person’s snack can be another person’s meal, and vice versa.
It’s all too easy to get tangled up in the words and lose sight of the tangible. Whether you call it a snack, a morsel, a banquet, an appetizer, a meal, or whatever—food is food. Regardless of how you label it, if it’s sufficient to trigger a spike then there are two choices and two choices only: correct it, or do nothing and live with the high. If the amount consumed causes the BG to go higher than you’re willing to accept, then you can either bolus or just walk away. The latter course is not generally recommended. At least I hope not.
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It certainly depends on what one considers a snack. A small piece of cheese or a handful of peanuts, fine, no bolus.
A bagel snack… Wth…
Certainly makes no sense as a blanket term without some substantial criteria regarding what a “snack” means in this context
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If you don’t mind me asking, how many units are you using for Tresiba? My mother now uses 23, last couple of days was 22. I just checked her sugar 4 hours post Humalog/meal and it was 125 to now 189 ( can you sense how frustrated I am)? a huge part of me just wants to increase the units to 30 because I honestly don’t see the 20’s working.
It may seem as though my expectations are high and in a way it should be, as it pertains to my mother’s health. I am just afraid that since her blood sugar seems to be in the 200’s more often than before, it will lead to complications…brief or long term. I emailed her doctor asking if I should increase her dose, called as well…left a voicemail…and nothing. At this point, I want to just increase her units to perhaps 29-30 because 23 seems to be doing absolutely nothing. I just checked her blood sugar and it’s 189…humalog ran out an hour back and she was 133 then. As for the book, I have read wonderful reviews about it and have just placed on order. Thanks!
how many units of Tresiba do you use? and how long did it actually take you to adapt to the adjustment phase? My mother’s blood sugar while fasting hits the upper 190’s to mid 200’s…Clearly, something is not normal here.
This sounds more like an under bolus and / or slow digesting food than a lacking basal.
Best way to determine if basal is sufficient is by skipping a meal entirely and seeing if blood sugar goes up or down or stays steady when there’s no other variables of food / bolus insulin.
The same can be accomplished by seeing if blood sugars rise or fall while sleeping-- though t not a perfect experiment because some people have blood sugars that rise in he morning no matter what…
But the fact that her blood sugar increased 60 points with a meal doesn’t really indicate that her tresiba dose isn’t right…
Increases like that without a meal would indicate that
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yep, she’s using humalog to cover for meals.
I use 24 units. But it’s exactly as Sam says, a basal insulin is only for when you’re not eating. Any food has to be bolused. It sounds like she prefers having more basal and having to eat some to keep her sugars normal and not going low. I wouldn’t bump it more than a couple units at a time and wait 3-4 days in between. She might actually need a few more units but you’ll never know unless you do what Sam says and go without eating and she is her sugars are stable. Maybe skip breakfast (including coffee) and see what her sugars are before lunch.
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My mother’s first endo said to only use 2 units of bolus for meals, regardless of how many carbs she eats. In all honesty, I don;'t think she understood how to carb count and how is more effective as opposed to the old school sliding scale crap they still use ( sorry, very frustrated with all of this ). Well, her rule of 2 units…LOL, didn’t clearly work and then I took her to another endo and she explained the whole carb counting/ration thing to me, which just m-a-d-e s-e-n-s-e. My mom is already going ape sht abt her blood sugar levels, saying she wants to go back to Lantus…and of course she is blaming me…as always. When all i want her to do is really, survive.
I remember the ER doctor telling me with a straight face, if your mom wants a snack and her sugar goes over 300, let it- it is okay bolus for her next heavy meal. I looked at her like woman, how do you seriously have a medical degree? I’m specifically afraid of the units for Humalog overlapping…such as,
8-12( breakfast) 4 units
then at 1 she says she’s hungry, she eats a chicken wrap ( 4 units)
then at 2:30, she is hungry again( would I bolus for a snack with the same carb count method or would I half it? because 1 pm bolus would still be active for 4 hours? My goodness, I think I just confused you right now. Yeah I just read the whole thing, it does sound confusing lol
thank you !
Oh and if it helps to know, her endo recently had her take a c peptide test and the results were 0.2. Endo initially had her on 25-26 units of Lantus but wanted her to start 22 units for Tresiba 