Awesome thanks Sam. I go to a new Dr (from the list here) on Thur and they said they have samples. Any tips on trying to ask for more 4’s, etc.? I finally am getting my CGM soon I’m so excited!
Peace bother
Hmm… I dunno… How you end up using them in terms of more 4s vs 8s will evolve as you learn how to use them. It really is all in the timing. If you’re not eating like a rabbit you’ll need quite a lot of 8s and 4s might end up being more for corrections…
It truly is all in the timing. Spend some time figuring out how your timing works-- it’s a different ballgame than injected but once you understand it’s about timing instead of dose, it’s phenomenal.
Thanks, Sam. So…you know you have the correct basal amount(s) when…what? Can you give numbers, examples please. That’s where no one has been able to guide me…1) you don’t drop - raise over night), 2) take enough so you drop to a good fasting number or wake up to a good number 80-120…so, obviously there’s going to be a drop. What is a good basal dose look like during the day? Endo just called in U100, think that’s going to be better for me; titrate with 1 unit doses.
Thanks!
Good basal dose, in theory (of course nothing is perfect) would hold your level steady. If you go to bed at 80-120 you’d wake up at 80-120.
Basal should not be dropping you from elevated to normal while you sleep. Of course variations occur, but that shouldn’t be the goal…
Good example— with a perfectly set basal if you wake up at 100, and skip breakfast, you’d still be somewhere near 100 before lunch.
With a good basal if you go to bed in-range you wake up in-range. (Some people have major struggles with morning rises though) so maybe a better example is keeping levels steady when skipping meals
this is what I don’t understand…because when one is first Dx we’re told to take and increase basal dose until we wake to a good fasting number. If your basal isn’t enough, one can correct after dinner, if high…but as soon as that bolus burns off, they’ll just climb high again. So, the basal does have to drop us? If after meals, we keep climbing to 200’s then we don’t have enough basal, which is supposed to lower us and keep us there? NO??? If I have to correct everytime my correction bolus burns out then I don’ have enough basal, which is supposed to lower me…???
Waking to a good fasting number with proper basal depends on going to sleep with a good number…
Basal should in a perfect world (of course nothing is perfect) hold you perfectly steady outside of meals without rising or falling.
If you’re climbing to 200 after a meal, that’s an issue with your bolus insulin, not your basal. With a good basal you’d stay right at 200 until you bolused it back down.
yes…but we’re type 1’s so we’re always rising, we’d be rising high enough until it killed us without insulin, of course…so the basal is lowering our blood sugars.
If I’m good, say 3 hrs ppl…but then start to rise isn’t that incorrect basal? IDK, I’m going to see my CDE again cuz I (we) just can’t seem to get this right.
Basal is just to prevent the rise that would otherwise be occurring even if you weren’t eating. That’s it…
yes, the rise because we’re type 1 diabetics who don’t’ make insulin…it’s not ‘just’…LOL, it’s the entire backbone and foundation to our entire basal bolus regime. when basal is incorrect, ICR ISF are off too.
I you’re eating a carb-limited diet and have a meal with substantial protein, then you could rise at three hours after eating. Some meals take longer to digest, including higher fat and protein meals. I take two doses of insulin for every meal. One is an immediate dose to cover carbs. The second is a protein/fat extended bolus spread over 2-3 hours using my pump. I could simulate this with MDI by taking a second short acting dose 1-2 hours after eating.
Ok, sure–but what that still looks like is steady levels with a properly set basal unless you’re eating — with your level staying right wherever food and bolus puts it…
If this is happening every single time you eat, it’s suspicious-- if it just happens once in a while it may be just a fact of life caused by slow digesting foods or physics that can cause slower digestion. The best way to determine if your basal is correct is to skip a meal or two in a row and see if your blood sugar holds steady, rises, or drops. Don’t start watching until at least 5 hours after your last meal and last bolus insulin so that you can be relatively sure that they’re not still in play… Don’t worry about the level, just look at whether it’s rising, steady, or dropping over periods of several hours at least-- while there is no food digesting and no bolus working, and also without any extreme physical variables like a hard workout—that’s how to adjust basal. In three hours within a meal there are too many variables…
Overnight is better too, but still some unknown variables due to dawn phenomenon. That’s why skipping a few meals and closely watching your blood glucose trends is the best way to see. It’s not an exact science— you’re looking for repeatable trends, not singular occurrences. Good luck!
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OK…thanks Sam. So, let’s say I’m just staying at 200, no meals, no working out, etc…doesn’t that mean my basal is holding me at 200’s (fasting) and I need more basal then to lower my fasting? I appreciate you taking time to help me with this.
I’ve done 6 u only of levemir at night, went to bed 189 no correction and woke up to 70’s my past CDE said that was good…I thought…hum, that’s nearly 100 point drop?
or if I correct, it comes down but as soon as bolus correction burns out it goes right back up again…say 150’s…I wake to 150, and my numbers after meals are always 150…doesn’t this mean the basal is just enough to get me to 150? If that makes sense? 
thanks!
So if you’re at 200— and your not working Out, haven’t eaten or taken any bolus in 4-5+ hours— and you stay at 200 all day-- that means your basal is perfect.
200 is too high though, so to lower it you would apply your isf and adjust it down with bolus to your target level
If you’re going to bed hours after eating and hours after bolusing at 200 and waking up at 100, your basal is too high. In my thinking anyway. Again-- not a doctor
Sorry for all the typos lying on a beach in Hawaii typing on an iPhone
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Oh geez, this is probably why I’ve been having so many problems. but sam, if I correct that 200 down and after 3.5 - 4 hours, when that correction has burned out (i still haven’t eaten or done anything) I go right back up to 200, isn’t that too high, if my blood sugars just want to stay around 200 the entire time then I need more basal…or I’d be correctly all day and night long, as soon as bolus correction burned out…I’d need more to bring it down again???
I’m sending you a ‘most helpful’ star - award right now. LOL
200 is too high though, so to lower it you would apply your isf and adjust it down with basal to your target level
adjust it down with bolus, no?
Yes I made a typo there— ALL of your “adjustments” are made with bolus not basal throughout the day…
If you’re continually shooting up to unhealthy levels like 200 without food on the picture, it sounds like you’re not taking enough basal.
Have you read the books “think like a pancreas” or “using insulin”. I found them really informative @KatieY12
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It’s important to understand though that im talking about concepts— you have diabetes. Your world is not a perfect one, neither is mine.
Don’t adjust your dose every time you have a “what the hell” occurrence-- you’ll be chasing your tail indefinitely. Look at the big picture— if you’re always generally rising throughout the day and while sleeping g you need more basal— if you’re always falling you need less— if you’re generally reasonably steady outside of eating, you’ve got it right.
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