Type 1 no bolus vs. One unit

Hey everyone, I am a 25 year old former college football athlete that was diagnosed with type 1 out of the blue last month. General physician had me on 25 units of Levemir a night and 3 units of novolog pre meal. After one day I found that the 25 units was entirely too much. We reduced it to 10, which worked great for a couple of weeks until my meeting with endo.
That is when I found out about the sliding scale and basal testing and what not. Reduced basal to 6 units, then split those to am/pm evenly. As my endo said might happen, my insulin needs have decreased over the month of treatment. I kept going low 3 to 4 hours post meal, obvious signs of too much bolus right? I have been averaging 60 carbs per meal, since I still play arena football and work out with intensity. Then it got to where even one unit for that sixty carbs was making me go low. What do those of you with honeymoon exper ience suggest? I’ve heard insulin helps preserve beta cells. Should I increase my carb intake and continue with one unit of bolus, or just continue with basal until bolus is needed? Had net carbs of 70 this morning, and 1 hour 20 minutes after I was at 170. Thanks in advance, this website has been such a help so far in this transition.


I guess I should say I did NOT take a bolus this morning and was 170 one hour after, 120 two hours after. Did not bolus yesterday any and had a high of 200, but that was after a traditional Sunday meal that I don’t normally eat. I was trying to push the limit to see what my body could handle with no bolus. Obviously 100 carbs isn’t it! But 200 still isn’t that bad for no bolus and 100 carbs in a meal right?

In the honeymoon period some docs like to keep us injecting insulin (even just one unit) throughout. There's some theories (don't know of any proof) that this might extend the honeymoon period. I don't know if your doc has mentioned "the honeymoon" but that sure sounds like what you're doing right now.

And yes I agree 200 isn't so bad.

A low 3 to 4 hours after the meal, might not be obviously the bolus. If it was happening 1 or 2 hours after the meal it would be less ambiguous.

There's also the very real factor that small doses get absorbed more rapidly and a basal of only 3 units will get absorbed a lot more rapidly than the advertised Levemir 24 hour length. You are already splitting it AM/PM I see, maybe the next step is to split it 4 ways that might just be self-defeating because the more ways you split it, the faster it gets absorbed! Like Mickey with all the brooms in Fantasia!

Thanks so much for the fast reply! I knew they said it was bad to stop taking insulin, but I didn’t know if that meant both basal and bolus or not. Didn’t know if the taking basal was enough. So do you suggest to take the one unit, then just eat a snack a couple of hours post meal to keep from dipping into the 60s?

Are you carb counting and adjusting the bolus to the carb intake ?
Sliding scale is an older/ less accurate approach. The basal/bolus approach
with the bolus adjusted for (a) carb count and (b) correction factor (if high or low)
is the preferred approach now.

Also, one thing I did when I was first diagnosed (about a year ago) and needed very little insulin was to get a pen that was capable of half-unit doses. This let me match the dose more closely to the need.

That way, you would have an option besides 1 unit or none.

The one unit may even be psychological rather than real :-).

Carb counting and basal setting can be really hard during the honeymoon, because erratic insulin production can dominate any of the other factors and make the math seem pointless. I don't think the math is actually wrong, it's just hard to know in advance whether the pancreas will put out a couple units worth or not on its own and that completely dominates the small changes you'd see from a single unit.

I am personally tending to believing that the problem isn't the bolus, but is the very small doses of Levemir getting absorbed rapidly.

Yes, being an athlete and into fitness and nutrition, I have been OCD about counting every single carb, subtracting the fiber, GI index, and any other possible factor. My wife (who has been absolutely amazing) says eating dinner with me now is like watching Einstein work a formula. I did all the calculations, where I thought I had an insulin to carb ration of 1:55 (9 total units of insulin, 1700 was my constant.) I have been a research maniac on all the latest everything. I also have been looking for .5 unit pens, but walgreens said they no longer can get the cartridges from their supplier. I have checked other pharmacies and they said the same. Unless they make a .5 unit disposable pen, which I haven’t found if they do, I am out of luck. Even so, the novolog junior had to start at 1 unit, and thus defeating the purpose, because I would need .5 units. From my own research, I have thought my two options would be increasing carbs until I find my true ratio, or just not take the bolus, and see how many carbs I can eat and stay regular. I just don’t like the fact of making myself eat more carbs just to cancel out insulin.

Tim, I am sorry, but I am a little confused. I basal tested overnight, and I did the morning, and my blood sugar during that testing only dipped 15 points throughout. I may be entirely wrong, but I thought that meant that my basal settings were accurate. If the rapid absorption was the case, wouldn’t it have dropped my BS during the night and/or morning tests?

I am in a very similar situation...I actually only bolus and do no basal. Have you tried that? I have no lows while exercising now which make me VERY happy!

Unfortunately I cannot walk a 1/2 dozen blocks without having low BG unless I make some kind of adjustment. You need some bolus insulin for food, but you can use some fast acting carbs before and during your football activity's. I have no idea what your insulin dose should be but I regularly cut my bolus in half if I'm eating before a planed activity and use some fast acting carbs if needed.

You will need to give yourself some time to figure out what you BG is going to do, based on food, type of food, insulin, and activity, diabetes also has some mystery variables just to keep things interesting.

Keep a log book and test, test, test. take it slow and you will figure it out. We are all different so there is no easy reference chart that will solve this type of problem.

Note: Many pro athletes will keep there activity level close to the same every day during the season so there basal insulin is a little more predictable.

During the honeymoon phase (and to me that seems to be exactly where you are, since you started out at large doses that have gone way way way down in the month since diagnosis) I wouldn't expect things to be so stable as to say that the basal testing done 2 days ago might still be accurate today. Spotting trends without re-doing the whole basal test, and tweaking basal and bolus based on those observed deltas, is far more commonly used.

Megan, I think (Tim may reply and prove me wrong, haha) my basals are good. By taking 6 units a day (split am/pm) my blood sugars have stayed stable. I am afraid by stop taking the basal, then my sugars will slowly elevate.

John, I am not sure exactly what you mean. I feel as if my body is taking care of my bolus needs. Right when, if I take one unit of bolus, I am almost always going to be in the 60s within 4 hours at least, some as early as 2 1/2 hours. I almost always end up having to eat about 10-15 fast acting carbs to bring me back up, hence the predicament of whether or not to just add those 15 carbs to my meal, or not take the bolus and not add those carbs. I just feel as if eating more carbs just to justify taking one unit of bolus seems a bit off, but that is my “pre-diabetic” mind thinking, it may be totally different now.

Tim, I see what you are saying. So what you are suggesting is maybe bump down to 2 units am and two units pm and stick with one unit of bolus and just see what happens? Should I do that for a few days to let my body get adjusted? Then if I am still going low bump basal down again, or do you really recommend taking the basal 4 times a day?

Although the pens are more convenient, if you find that you really need the flexibility to dose in 0.5 unit increments, you might try using vial and disposable syringes in 0.5 unit increments.

Tim, it looks like you were correct in stating that it is the basal. I am 4 hours post breakfast and I am down to 62. That’s after I didn’t bolus anything for the 70 carbs this morning. I swear, if I hadn’t read everything about the honeymoon period, I would be convinced my diabetes has just left me. I guess I should enjoy this while it lasts, and in the meantime just keep adjusting things. I have no clue.

The novoPen Jr is a half unit pin. I have one and have used them for years to do
corrections on MDI. Ask your Endo for one

Yeah, I ran track in college starting about 4 months after my diagnosis.

I was on NPH/R and knew nothing about carb counting or basal testing at the time. Based on what I can remember, I was probably eating over 500 g/day of carbs and I was taking ridiculously low amounts of bolus to cover my meals, if any at all.

I was constantly fighting lows but through trial and error I knew I had to keep taking insulin in order to get me through weekly workouts. Maybe not with every meal but I definitely had to maintain my basal and balance my bolus with daily activity. My first season was rough and I was constantly toying with my diet and insulin doses from week to week.

If you have been basal testing and understand carb ratios, then you are ahead of the game and doing everything you can do. I imagine that maintaining your weight is probably an issue so I imgine you can probably tolerate a few extra carbs without screwing your BGs over too badly.

We all want to maintain near normal BGs but I think, as an athlete going through a honeymoon period, you can probably deal better with BGs on the higher end to mainatain your workout schedule.

Oh definitely.

About 5 years on into my diagnosis, I was still training and my dosing hadn't changed much at all. It took a couple years to work out my dosing/diet/training regime but I was on cruise control. I honestly stopped thinking of myself as diabetic. It was fantastic!

It took awhile, but it did hit me a few years later and I went through a whole period of denial, despite one bad endo visit after another.

Definitely enjoy it now, get a few years of practical knowledge working through your dosing issues, but definitely be ready to hunker down and really put that experience to good use later when, in many ways, thing will not be as easy.

kinda the same thing happened with me, DKA..put on a higher dose of insulin, then kept tweaking it down. However, at this point, both my fasting and meal insulin production was failing...so, I always had to be on a basal; I cut back to only 3 units lantus initially and ate no more then 15 carbs per meal w/no insulin (I could still handle about 15 carbs w/out insulin)...i did that for a while, as I was in a honeymoon stage. Had to eventually increase my basal...and, of course, even the low carbing didn't work after a few months. So, now on basal - bolus, going on a pump. the honeymoon phase can be just as tricky...I still think I'm going out of it...still titrating insulin doses. I too am very insulin sensitive...and need still small amounts, 8 maybe 9 units basal. Yes, you can take 1/2 units, both in a syringe and/or novo junior, I use them both.

Yes, that's the one I was referring to. One click is 0.5 units. Though you will waste 2 units priming it. I didn't care. The cartridges seem to be widely available