Hi guys, been a while :)
Things have been running smoothly, and despite a high level of exercise, i have somehow ended up about 4kgs heavier than i would like. I have started to tighten up my diet a bit over the past few days(its the offseason here for triathlon!) and thus have reduced my bolus insulin usage despite maintaining good numbers. That being said, i have a few questions for the wise!
Firstly, i still inject with lantus and have done since dx in jan 2012. I jab 10 units at night. I have often found that i can bolus for breakfast as per normal (and end up about 4.8mmmols 2 hours after), but for a mid morning snack (and afternoon snack) i can get away with an apple and a protein shake and 2 hours later, i will be something like 4.7mmols again. Today, i was 3.7mmols 2 hours after an apple and protein shake again with no bolus! Based on this, and as a weight loss issue aswell, should i lower my basal slightly?
Secondly, also from a weight loss perspective (im only talking a few pounds here) does lowering a basal vs reducing a bolus differ? For example, if im reducing bolus injections but can get away with eating fruit at certain times of day, should i maintain this schedule OR would i be better off lowering my basal and bolusing for things like the fruit? My BS is fairly tight, hba1c's of sub 5.5 since dx. Thanks for the help, my educator isnt very good with exercise/diabetes questions :S
Hiya Timmy,
Quiz time:
I see you bolus meals but not the snacks right? (which insulin are you on?)
Would you say that your BG is flat when you fasten besides this specific episode?
Have you changed something in your habits besides the diets?
Secondly, also from a weight loss perspective (im only talking a few pounds here) does lowering a basal vs reducing a bolus differ?
My answer is a bright YES! This is not about losing weight or not. Your basal should make your BG flat in the background (id not covering meals or snack). It's the bolus insulin that takes care of the eating part.
If you want to test your basal try this: Basal Test
Just to be cautious I would suggest to be conservative and slightly lower your basal while you study the phenomenon.
Would the beta cells reduce their insulin production to allow weight reduction? No, they would just measure the blood glucose and produce accordingly. So are you injecting more insulin than you would normally produce for yourself? Very likely because the beta cells are tightly synchronized with the BG producing micro bursts of insulin. Insulin does interact with a growth receptor of cells. But is this really significant for you? I mean 10 units is a good insulin sensitivity for your weight. It shows the high muscle mass you have managed to built up. Whether you are injecting 7 or 10 units will not do that much about the insulin to growth receptor reactions. Overall the connection to the growth receptor is less likely than to the insulin receptor. For T2 this is very different because they inject so much more insulin to overcome the resistance of the insulin receptor while having a normal reception to the growth receptor. For them this leads to much insulin induced growth. But for you I doubt it. Perhaps much of your weight is indeed muscle mass?
i do have a bit of muscle mass, but i assure you, i can drop a few pounds on top ;)
im not heavy by any means, but for my sport (triathlon) i wouldnt want to get any bigger
hi rick!
1)yep bolus meals, not snacks unless i go nuts at carbs (never for snacks) but i can get away with something like an apple or low sugar yoghurt etc.
2) would the bs be flat? i would say yep, BUT it does fade and dip if i dont eat something every few hours. There is no way it would be flat if i didnt eat something.
3) i ate fairly 'bad' for a few weeks, hence the smallish weight gain. Insulin went up by maybe one or two units a day, nothing extreme at all.
As metioned im only on 10 units of latus, novorapid covers the bolus. I exercise around 11 hours a week.
For most NovoLog/Rapid has a tail. In most cases this is benefitial to cover those parts of the meal that are digested later. However if this lead to lows later you could think about:
a) replacing NovoRapid with Apidra. This insulin is less likely to have a tail. Usually it also acts faster than NovoRapid. Perhaps this would lead to less snacking in between?
b) the orchestration between bolus and eating could be adjusted. Perhaps your waiting time is too long - leading to the low later?
I tend to attribute weight gains to running my insulin a bit "hotter" than it needs to be. If my training is down and weight is up and I am seeing a weight gain, even just a few pounds, I'll look at what I'm eating and sometimes see a lot of unbolused snacks of some sort, hypo treatments, etc. Maybe just a few hundred calories but, if I don't need them, I'll try cutting my basal back maybe .025U/hour which would work out to maybe .6U/day, not a huge amount but it can make a difference. If I dial it back .050U/hour, that'd be about 5-10% of the total daily basal insulin and maybe help just eliminate those particular snack. Sometimes too, I'll replace something like yogurt w/ a bag of veggies. Same approximate # of carbs (7Gish) but maybe processes a bit differently somehow.
I was gaining weight and switched to Levemir and started on Symlin- to control hunger feelings- I didn't really need to lose weight but I had gained back dka weight loss and was worried I would continue to gain more. I'm also hungry on novolog and insulin in general. So I think I've lost about 5 pounds or more now without changing diet. Lantus is apparently known to make you gain weight. There is no dosage change when switching from Lantus to Levemir.
your prob right, but since my a1c's have been good, i dont think the doc/endo would agree to change out my lantus
In my opinion your basal during day time is too much.
The right amount should keep your BG flat when fasting (id without having to snack to prevent hypos).
Since your A1C is that good I assume during the night your basal is correct right? I mean if you go sleeping with your target BG (let's say 90) you wake up at the same level, is this the case?
Also, how many hypos do you experience a week? (just to see if A1C is low bc of flat control or that's just the average).
It seems I'm making more questions than answers ;)
I’d say that if you can eat an apple and protein shake with no bolus and still be 3.7 then your basal is definitely too high. Basal is supposed to keep you just flat - there should be no need to “feed the insulin”, so to speak. I would definitely do some basal testing if this were my situation. Good luck figuring it out!
mine are good too, if you ask him/her to do it they should do it, if you're gaining weight on lantus that's a good reason to switch it.I agree about reducing basals too.
i think this is a YMMV, novolog has no tail for me, in and out of system, either pump or MDI in about 3 to 3.5 hours, peaks at about 1.5 hours.
10 units suggests still beta cell function and production of natural insulin, he was diagnosed in 2012...so, still honeymooning, obviously.
haha no problem re: questions.
This is the thing with my basal. Because i almost always exercise in the late afteroon/evening, i allow for an upcoming dip in blood sugar. So, i may bolus slightly less for dinner etc, and have a reading of like 7 mmols. Hit the lantus of 10mmols, and often wake up in the 4's/5's. Hypos, i would say i get in the 3's about 4 times a week. i may see 2+mmols once every 3 weeks.
Anyway ill give you an example of last night/afternoon. I ran 21kms at around 4m50 per/km pace. I documented what i ate the whole way (1hr35 of running). Prior to starting i was 4.7mmol, too low for exercise. I had 3 dextro type of glucose tablets and from there on in it took me another 17 glucogel jellybeans to see me through. It was 250 calories of glucose/sugar to keep me 'up' during the run. That evening had dinner, and allowed myself to hit 7.5mmols before bed and jabbed 9 units of lantus. I woke this morning at 4.2mmols.
Granted i dont always exercise that long etc at night but i always do something which tends to lower my bs afterwards so i allow a small spike before bed. I do believe my 10 units is perhaps too much, so thats why i tried 9 last night.
Allowing for these dips may be a dangerous type of game, but i have ever woken below 3.7mmols. A touch low, but nothing disastrous. i will keep adjusting the lantus and will bolus more if need be i think.
yep dx jan 2012. I didnt think honeymoons lasted this long!
it doesnt hurt to ask ill give it a shot. my BMI is 23 and im not overweight by any means, but for my sport im starting to get a bit too big so the doc might just laugh at me :S....
thanks! im going to adjust the lantus dosage and see how i go
ok.. great! It may help you.. I don't think he will laugh.. I'm glad I switched to levemir. I don't want to gain weight, it's just not healthy imo especially with D. I'm not a sports person really, I just do walking, gardening etc. I may start swimming a bit again.Another thing my endo mentioned about Levemir is that he thought it would keep me more stable than Lantus as I tend to spike up alot when basal runs out.
My experience in training and diabetes is not that great. However, I would see training as a "basal" itself.
When I was doing Thai Boxe I had to reduce my basal by a big amount.
Also I knew a guy which was a goalkeeper coach in a famous football team who told me sometimes he beats his own diabetes. As a matter of fact he was skipping boluses and eating to keep his BG in the target range. But I suppose he was still a bit honeymooning.
I see that you feed yourself pretty much while training and that's ok. But I would try to reduce more your basal and keep away from the roller coaster you experience. In the end it's a no sense having more insulin and oblige yourself to eat to prevent hypos.
Try to find the right basal amount which can keep you BG flat and make you free from thinking how not to go down.