Got it…thanks! read both books…still don’t know how to apply it to me…I have
what the hell occurrences every frickin morning…seriously. ;0 plus I’m so insulin sensitive .5 unit can drop me 70+ points sometimes. I think then I am going to go to 6 units tonight and just stay there for 3 plus days. THANKS SAM…SAM I AM. 
Ok just to point out the obvious— you’ve gone from 8 to needing less, to needing more, to now needing less again in two days now with a medication that requires 3 days to see if you need more or less. It’s shaping up like you’re setting yourself up for difficulty at this rate… Just trying to help.
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I know…because I thought it was supposed to lower our blood sugars, I was
told take enough until you wake to a good fasting blood sugar (that how we
all start) If it’s not supposed to lower BG’s then I think 8 is too much.
Again, i have no idea? But I don’t think 6 units basal is enough for any type 1?
I’d give it three days and then go from there when you’ll be able to make more informed judgements
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OK. thanks! i’ve stayed on 8 units…tonight will be the third night.
The following is straight from Gary Scheiner’s mouth (he’s the author of Think Like a Pancreas and owns and manages Integrated Diabetes Services, in addition to having Type 1 diabetes himself.) Gary is an expert in the field and clearly knows what he is talking about.
This is how basal works: When there are no other factors in the picture (e.g. changes in BG due to slow digesting food, inadequate boluses or corrections, boluses or corrections that are too high, exercise, stress, “pre-” illnesses, changes due to menstrual cycle, the day of the week or the alignment of the planets, etc.) basal insulin keeps your BG steady. It should not increase or decrease your BG per se. For example, if you hadn’t eaten or corrected in hours and your BG is 200 (or 150 or 327 or any number for that matter), if your basal rate is “accurate” and you take no other actions that change your BG, you will wake up with the same reading that you had when you went to sleep. If you went to bed with 200, you’d wake up with 200. If you went to bed with 78, you’d wake up with 78. Basal insulin is not meant to correct BG when it is high or low because your I:C ratios or ISF are not correct. If you went to bed with a BG of, say 200, hours after eating or making any corrections and you woke up with a BG of 100, this would mean that your basal dose was too high. Basal insulin should not correct BG that is high because carbs aren’t counted correctly or because you didn’t factor in slower digesting fat or protein, or because your I:C ratios are too high or too low, or because you have under- or overestimated your DIA, or because your ISF (a.k.a. ICF) is incorrect.
I highly recommend re-reading (and re-reading again if necessary) Think Like a Pancreas because it’s all there and was written for everyone with diabetes, regardless of Type (although IMO, this excellent book is directed more towards those with Type 1 or those with Type 2 who are taking insulin). If it still doesn’t make sense to you, you should consider the on-line classes offered by Integrated Diabetes Services’ Type 1 University.
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Why do you think that? Some people with Type 1 would go dangerously low with more than 2 units of basal insulin. You need what you need regardless of the Type of diabetes!
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I’ve read the book I also know Gary. Yes, that is how the concept works and that’s also factoring in someone who’s on an adequate basal dose. I’ve always been told, when first starting out…take enough basal so you wake to a good fasting blood sugar, at least that’s how we start out…? Time and time again…take enough so you wake to a good fasting BG 80 - 120. IT MAKES SENSE to me…but guess you should then send this to CDE and Endo so it makes sense to them. crackin up.
I believe that what they’re trying to convey is that, if your basal dose is “correct” you should wake to a good fasting blood sugar if you went to bed with a good fasting blood sugar in the first place.
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You’re correct, I don’t need to respond. But you’ve come to this Forum asking questions and writing things like “I thought it [basal] was supposed to lower our blood sugars, I was told take enough until you wake to a good fasting blood sugar” (your words).
So folks like myself and Sam19 and LADA_lady and others take time and attempt to answer your questions. Then you don’t like what we have to say…
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thanks…well, yes…but i was responding and interacting with Sam, the question was asked and answered kindly by him. i also wrote exactly what was conveyed to me so it’s not productive to tell me something else was ‘conveyed’ or answer in a condescending manner…LOL, what’s the point in that. I wrote what was said, “take enough basal, titrate up, until you wake to a good fasting BG.” shall I copy and past the mychart conversation?. I’m good, thanks. many t1’s still honeymooning only use basal at first, depending on what stage they’re in in terms of the autoimmune disease - islet (beta-alpha) cell destruction. it does indeed lower their blood sugars b/c they’re not using anything else.
But your questions were asked in the context of a MDI regimen in which you state that you are using both long-acting and rapid-acting insulin.
As far as being condescending…well, my daughter once said (and I’m sure she likely heard it from someone else, who heard it from someone else) that “You can’t hear tone of voice in a text or post.”
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There are lots of discussions about dawn phenomenon (DP) here, so without being too repetitive, I think one thing to remember about basal doses and the “wake up at the same level you went to sleep” mantra is that if you have a strong upswing in bg’s during dawn hours it will make you think your basal rate is too low when it might be just fine (depending on when you normally wake up of course). This is where the cgm is great. If you’re level from bedtime to, say, 4am, that’s a sign you’re probably doing okay, even if your bg’s trend up from 4am onward. Plenty of folks here bolus in the morning just for DP, with zero carbs involved. If that’s your situation, don’t let the post-4am trend over-influence how you’re figuring your basal rate.
Exactly! Which is part of the point Sam and I attempted to make: that basal should keep you level absent other factors such as DP.
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also, if one is on a pump, the body doesn’t know the difference between basal and/or bolus, it’s the exact same insulin…the body just uses it how it needs, of course it lowers BG’s.
Also just noted that you say you’re in honeymoon period, so in that case, count on the one thing you’ve already figured out: what worked this week will change the next!
thanks. I’m fully aware of DP I (we) think I swing more in the way of Somogyi effect. not sure yet. Or, it could simply be basal not enough or basal running out (levemir) or, yes…DP. It’s very difficult to tell. I’ve never woken to a good BG, or a viable trend. as I’ve said…I’m either correcting one way or the other. Also, NO…I am not in my honeymoon. I’m 5+ years into this. That was a honeymoon analogy.
sometimes people just click with someone or feel comfortable in taking his/her advice over someone else’s. That’s just how it is…you also correct your daughter’s BGs at 120, that could kill me, most certainly. And, I’m probably your age and not at all new to this.
As I said, I’m appreciative and Sam made it clear by answering my questions. I’m good…thanks!
I thought the honeymoon phase was really difficult, so I guess that’s good news.
I haven’t looked at all your other posts – do you use a cgm?
I respectfully disagree. The way in which the exact same insulin is dosed makes a huge difference. Basal insulin, when it is in the form of rapid-acting insulin that is administered very, very gradually via a pump, attempts to mimic the action of a “normal” pancreas which releases endogenous insulin in a similar fashion to maintain a healthy BG, not to lower it. Another way to look at this is to say that basal insulin is meant to prevent BG from rising in the absence of other factors, which is different from saying that basal insulin lowers BG. However, the exact same rapid-acting insulin, when administered in significantly larger doses as a correction or a bolus is “supposed to” lower BG or prevent it from increasing in the face of carbs or other factors that increase BG.
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