I need a basal expert please!

[kel4han]

I was told to adjust basals no sooner than 3days, becuase it isnt truely working as it will until day 3..... is that right?

OR

Is it just becuase you are watching the pattern for 3 days and adjusting from that info?

Just ending my honeymoon, and started on 2 tiny units. I am 5'5 115lbs. It could take me forever to get it right if I have to wait 3days. I understand the logic of waiting the 3days, but geez. I feel like **** waking in the mornings in the 140's. I need a pronounced basal expert please!

[BlueSky]

If you think that a lot more basal insulin is required, you can increase the dose in 2 unit increments until you get it about right. You can then fine-tune the dosage amount by making single unit adjustments and/or splitting the dose. But you should stick to the 3 day spearation between changes. It really isn't possible to see a trend in less time than this. Also, while adhusting your basal dose, avoid eating foods that cause big BG swings as this just confuses the issue.

[SunniD]

You do need a period of time for your long acting insulins to clear thru your body. My CDE is Gary Scheiner who wrote the book "Think Like a Pancreas" and if you only wish to do the
basal testing once, then wait the 3 days. If you start it too early, you will be doing it more than once cause your old insulins won't have totally cleared thru your body yet.<smile>

SunniD

[someone]

With Lantus, you need to wait a little longer, but 2 days is probably sufficient. If you are waking up 140, that isn't too bad.. I would just increase the Lantus a tiny bit every 2 days until it is right.

When I was on Lantus I was very impatient too. I usually ended up making changes every day, and it just messed me up even more.

[grace girl]

I'm on Lantus, and I can tell you from much experience that after you've changed the dose, you have to wait three days before making another change. I know how irritating the wait can be, but it really doesn't have stable results until after three days. I was told that I could make up to two unit adjustments at a time, but I usually do it 1 unit at a time because I'm pretty sensitive to lantus. Getting it right takes some patience. Hang in there, you'll get it!

[dar917]

So, they didn't really explain this to me when I was in the hospital so let me see if I'm getting this right just from what I'm reading on here:

Your basal rate is how much insulin you take at night, say 14 units of Lantus if you take that, is that right?

They told me to take 14 units of Lantus at night. OK so I did for a few days till my BS came down; I didn't want to take 14 when my BS was like 110 before bed time. So since then I've been guessing based on what my BS tests at at night. I guess I've been doing it wrong all along! :( (Tonight I was 226, I took 12 Lantus. This afternoon my mom and I went to a movie; I was 87 before we went so I had some popcorn and a couple hard candies and was like 218 when I got home. Argh.)

[mortis505]

I started on 25U Lantus per night after the hospital. By using the 3 day rule I was able to slowly dial it down to 18U per night before I went on the pump. It takes a bit of patience, but by going slowly you will begin to see where it starts to make a difference in your numbers.

[duck]

So, they didn't really explain this to me when I was in the hospital so let me see if I'm getting this right just from what I'm reading on here:

Your basal rate is how much insulin you take at night, say 14 units of Lantus if you take that, is that right?

They told me to take 14 units of Lantus at night. OK so I did for a few days till my BS came down; I didn't want to take 14 when my BS was like 110 before bed time. So since then I've been guessing based on what my BS tests at at night. I guess I've been doing it wrong all along! :( (Tonight I was 226, I took 12 Lantus. This afternoon my mom and I went to a movie; I was 87 before we went so I had some popcorn and a couple hard candies and was like 218 when I got home. Argh.)

The timing of your basal insulin has nothing to do with the fact that it is a basal insulin: Basal insulin is you BASE insulin, in theory. It is called "basal" because it is supposed to support your body's BASAL Metabolic needs--I didn't know this for years as a diabetic, but human beings are glucose-producing machines. If you could remove someone's insulin-making cells right this instant, in a couple hours their blood sugars would be higher, whether or not they ate anything. And as time goes on, your blood sugar generally increases without insulin compensation, whether or not you consume anything caloric. Your basal metabolism has the effect of putting glucose into your system from its various stores for various reasons.

SO, then, the strategy is to cover your basal metabolic needs with a basal insulin (hence, the name). In theory, under this strategy, if you took your basal insulin and ate NOTHING for the next 24 hours, your blood sugars should stay consistently the same all day long, just like a non-diabetic.

Of course, most of us eat a couple few times in a 24-hour period, and for those meals we cover with a fast acting insulin (sometimes referred to as a "bolus" insulin, but "bolus" in the context of insulin is basically a shot).

Hope that helps--it's confusing at first.

[duck]

They told me to take 14 units of Lantus at night. OK so I did for a few days till my BS came down; I didn't want to take 14 when my BS was like 110 before bed time. So since then I've been guessing based on what my BS tests at at night. I guess I've been doing it wrong all along! :( (Tonight I was 226, I took 12 Lantus. This afternoon my mom and I went to a movie; I was 87 before we went so I had some popcorn and a couple hard candies and was like 218 when I got home. Argh.)

Okay, Dar, I should be in bed but I just re-read your post and I want you to go back to whoever trained you and kick them squarely in the butt with as much force as you can muster.

Alright, what other insulins are you using? Lantus by itself is not typically sufficient for a Type 1, unless there are other outlying factors (honeymoon, pre-diabetic, etc). Second, as I described above, in theory Lantus shouldn't bring high blood sugars down, it should basically keep you stable where you are when you shoot it up...even if you don't eat anything (exercise, stress, etc. will make me a liar, though). If you are a typical Type 1 (and we are all at least a little bit different), you need to bolus with a fast-acting insulin anytime you are ingesting carbohydrates.

[dar917]

in theory Lantus shouldn't bring high blood sugars down, it should basically keep you stable where you are when you shoot it up.

I see. With me it works to bring me down though; I was 226 last night, took my Lantus, at 3 am I was 90, and 100 at 8:30.

I also take Novolog with meals.

Can I just say how glad I am I found this site? :D

[duck]

I see. With me it works to bring me down though; I was 226 last night, took my Lantus, at 3 am I was 90, and 100 at 8:30.

I also take Novolog with meals.

Can I just say how glad I am I found this site? :D

Alright, I don't want to hijack kel4han's thread, but we need to sort this out for you...I should say in theory, a proper dose of Lantus should not manipulate your fasting sugars...In other words, you take the proper dose, you should stay the same blood-sugar level aside from eating and exercise, etc. If you take too much, then certainly Lantus can drop blood sugars, but that's not what it is designed to do.

NOW: We can figure this out, but to do so, you'll need to provide in detail: What time you take your shots.
What sort of shot it was (Lantus, Novolog).
How much insulin each time.
What time did you eat?
How much carb and protein?
What were your blood sugars before eating?
Two hours after? Four hours after?

Also, to properly assess basal needs, one needs to starve themselves for a few hours. It's not really torture, but it will feel like it. :D But we'll burn that bridge if we come to it.

[LancetChick]

The three day rule certainly doesn't apply to everyone. I can tell the same day (hours), or the next morning how a basal change is working. And I don't limit changes to a unit or two at a time...... if I've been drinking wine for several nights in a row, for example, I'll go from a wine night dose of 2 or 3 units to a dose of 9 units the next night when I'm not drinking. And the opposite is also true, going from 9 units to 3.... the difference will be apparent right away. I'll stay on the 9 unit dose as long as I'm not drinking wine, adding NPH as needed for DP. If I had to wait three days to make sure a basal regime was working, I'd be so frustrated!

[dar917]

(From a different thread)
what you could do, is have her fast for 6 hours, to see how her numbers are.. one day eat dinner, a bed time snack and get a minimum of 8 hours of sleep then no food until lunch time, and checking hourly.. and then the next time.. eat breakfast and then fast and check hourly until dinner, and then the next day.. eat breakfast, lunch and fast until am, and check hourly.. and see how her blood sugars do durring those times of fasting.. if her numbers are up, then it would be the basel rate, but if it is normal, and her sugars are still up there, then it would be the bolus that she is doing for the food that she eats.

OK I think I get how to do that. Every hour though? I'd need an unlimited supply of test strips to do it. :s:

Thing is the Lantus works well to bring me down overnight; last night I was 224, took 12 u. and was 85 this morning. :confused:

Oh and I still haven't seen the results from my CGMS test last weekend; I'm quite pissed off about that.:mad:

[Dervish]

Thing is the Lantus works well to bring me down overnight; last night I was 224, took 12 u. and was 85 this morning. :confused:

It's nice that your Lantus is working well to bring you down overnight, but that's not the function it's designed for. A dose of Lantus big enough to bring you down to 85 by morning when you go to bed at 224 is also a dose of Lantus big enough to send you into a (potentially severe or even life-threatening) hypo when you go to bed at 124.

A perfect dose of Lantus will see you waking up at 224 if you go to bed at 224 or at 85 if you go to bed at 85. If you're at 224 at bedtime, you're absolutely right to want to wake up at 85, but the right tool for accomplishing that is your rapid-acting insulin (Novolog, Humalog, Apidra, Regular...), not Lantus.

[xMenace]

It's nice that your Lantus is working well to bring you down overnight, but that's not the function it's designed for. A dose of Lantus big enough to bring you down to 85 by morning when you go to bed at 224 is also a dose of Lantus big enough to send you into a (potentially severe or even life-threatening) hypo when you go to bed at 124.

A perfect dose of Lantus will see you waking up at 224 if you go to bed at 224 or at 85 if you go to bed at 85. If you're at 224 at bedtime, you're absolutely right to want to wake up at 85, but the right tool for accomplishing that is your rapid-acting insulin (Novolog, Humalog, Apidra, Regular...), not Lantus.

I agree with the going to bed at 224 part. That definately suggests risks. But I caution on the expected effect of overnight Lantus. Beware the Somogyi phenomenon (http://www.diabetesselfmanagement.com/article.cfm?AID=2161&SSL=n&page=4) and other nighttime patterns. Everyone on insulin should basal test in the night to find out their own unique tendancies.

[dar917]

A dose of Lantus big enough to bring you down to 85 by morning when you go to bed at 224 is also a dose of Lantus big enough to send you into a (potentially severe or even life-threatening) hypo when you go to bed at 124.

Well duh captain obvious, that's why I don't take that much if I'm at 124, I take like 10 and then it stays pretty stable. >.<

[duck]

Well duh captain obvious, that's why I don't take that much if I'm at 124, I take like 10 and then it stays pretty stable. >.<

Dar...You are using your Lantus all wrong. YOU DON'T TAKE IT TO LOWER YOUR BLOOD SUGAR. You take the fast acting for that, if you are higher than your target. You take your Lantus to keep your basal rates stablized, and that's ALL you use it for.

[dar917]

YOU DON'T TAKE IT TO LOWER YOUR BLOOD SUGAR. You take the fast acting for that, if you are higher than your target. You take your Lantus to keep your basal rates stablized

I get it, knock it off. But if I'm 200 at bedtime and take 5 u or whatever of Novolog plus whatever of Lantus won't it go too low then? I'm so confused. *headdesk*

[LancetChick]

I get it, knock it off. But if I'm 200 at bedtime and take 5 u or whatever of Novolog plus whatever of Lantus won't it go too low then? I'm so confused. *headdesk*

You need to determine your ISF (Insulin Sensitivity Factor) or Correction Factor, or how many points one unit of insulin will bring you down. First, though, you need to set your basal dose correctly.... after that, the ISF and insulin to carb ratios can be more accurately gauged. A great book that explains all of this is Using Insulin (http://www.diabetesnet.com/ishop/product_info.php?products_id=395&osCsid=a5ffe43d93f0b54f536abc276caa0788) by John Walsh.

[dar917]

OK, I talked to my doc today (over the phone though, he's at my hometown clinic 35 miles away); the results from my CGMS test FINALLY came back. He said my numbers looked good and I asked him about my Lantus dose and stuff and he said 10 units should be fine and if I'm over 200 at bedtime I should take an extra unit of Novolog. I have yet to see the graphs but he's going to mail them to me. He says I would go up between 9:30 and 10:30 or so and then go down till about 3 am and then level off; sounds about right. I feel better now.

[duck]

For me, 1 U of Novolg would bring my blood sugar down 40 points in four hours (that's my correction factor). I would assume that you wouldn't come down more than 60 points in an hour, as that would be REALLY sensitive to insulin, and as far as I know, there is only one or two people here in the entire family that is that sensitive. We need to figure out as soon as possible how well the Lantus is working as a basal--without getting the basal dialed-in, everything else is conjecture.

[dar917]

bump!
OK I have a new question. Is it better for your bedtime numbers to be a little high or your morning fasting numbers? I recently started taking my Lantus in the morning on account of my music rehearsals and stuff in the evenings. Since then my morning numbers have been between 120-138 or so. Before switching my evening numbers were mostly between 140-200ish. When I switched over I did a two dose day and my numbers that day were higher than usual.

Should I just go back to an evening dose? What would you guys do?