So last summer at camp I met a young girl with type 1 who said that she liked to use her basal to help treat her highs. I had kinda forgotten about that, but last night my daughter (who is 10 years old) was 20 (360) before bed. And I know, I know, it’s AWFUL, but she had forgotten to bolus for a snack in the afternoon so she started into a pizza dinner high and obviously hadn’t come down yet.
But I suddenly remembered about using the basal to help treat a high so I lowered the correction bolus that her pump wanted to give her and upped her basal to 150% for an hour. Now I know what her basal settings are, so adding 50% wasn’t giving her a ton of extra insulin, but it seemed to work really well. An hour later she was 13 (234) and she rarely comes down that quickly without exercise. When I checked her again at 3:00 am she was sitting right where I like her.
Has anyone else had any luck with this? Oh… uh oh, I’m realizing this just might help with extreme highs like we get. My daughter is a spiker, and although we avoid process foods and sugary drinks and desserts, it doesn’t seem to take much. Thankfully she doesn’t get ketones, has only had them once, and that was went a site failed over-night.
I have done the same, also with similar results of the high BG coming down quicker.
My theory is that the higher Basal stops or slows the glycogen release from the liver so that the correction bolus is more effective.
I also use afrezza for corrections, and find the same effect with basal boost on my pump.
I like to think of the insulin basal rate as a platform from which to launch insulin boluses to cover meals. If the basal platform is decaying or soft, the meal insulin doses must first backfill the missing basal and then can’t do all the meal work intended. You know your BG is high, so you know your need more insulin. You can only deliver insulin in two ways, immediately (bolus) or over time (basal).
If it’s just a garden variety BG like a 180 (10) after a dinner carb miscalculation and you know your basal is solid then a simple correction will often do the trick. But if I’m seeing something north of 240 (13.3) and heading higher, I will often use a correction bolus combined with a basal increase. In fact the basal increase is the primary mechanism that my Loop hybrid artificial pancreas uses to pull down highs.
I use Afrezza (powder insulin) and intramuscular shots to correct high and trending higher BGs.
In direct answer to your question, I often increase basal and bolus to correct a high BG.
Edited to add: I’m talking pump basal above. MDI basal insulin is different and this technique does not work with MDI basal (NPH, Lantus, Toujeo, Tresiba). See @David_dns’s note below.
I will often bump up my basal to 110-120% for two to four hours to help treat a 200 especially if my blood sugar is relentlessly marching higher rather than spiking.
I am on MDI. Would using the basal (Levemir) help me with highs? I am Type 1 using Novolog and Levemir. I have been giving one injection of Levemir at night. Sometimes pizza or another food that causes highs calls my name so loudly and repeatedly I just cannot ignore it and then all hell breaks out with my glucose readings. I had never heard about using a basal for this, but maybe that is only for people on pump? Thank you for any advice.
That’s not a good idea, and in any case it won’t work. There is a distinction here that is critical to understand.
“Basal” has two entirely different and distinct meanings depending on whether you are using MDI (like you and me), or a pump. The term means something quite different to a pumper.
With MDI, basal and bolus insulins are chemically different, and their rates of absorption (and thus time to act) are radically different. Bolus insulin works right away, or nearly so, whereas basal insulin is released very slowly over 12, 18, or even 24 hours. This is entirely different from what happens with a pump.
Pumps use bolus (fast acting) insulin exclusively. What a pump user calls “basal” is simply a tiny trickle of fast acting insulin released by the pump. It is feasible to simply increase the “basal rate” for a while to knock down a high, because all you are really doing in that case is administering more fast acting insulin. Quite different from what you and I are able to do.
So using an increased dose of MDI basal insulin not only won’t fix the current high, it’s almost sure to lead to an eventual low some hours later, which you will then be fighting for the rest of the day. That’s not just inconvenient—it’s dangerous. Bad idea all around.
Thanks all! I will definitely then keep using this technique to bring down my daughter. It’s just crazy that I had to learn this from a 15 year old and not from our team.
My daughter is a spiker, and although we avoid process foods and sugary drinks and desserts, it doesn’t seem to take much. Thankfully she doesn’t get ketones, has only had them once, and that was went a site failed over-night.