[foxl]

Okay this may sound like a dumb question on the face of it, but I have read that some docs start you on bolus-only, others on a basal-only regimen.

I probably do not have huge needs for insulin at this time, since I am well controlled with low-carbing and oral meds. I am just beginning to think on these ideas.

So ... those of you who began with basal-only or bolus-only regimens, did you try the opposite, and please share experiences with starting on whichever, in general?

[rak1978]

I was put on a basal and bolus immediately upon diagnosis.
That's an interesting question though. I've never heard of giving one without the other. I learn something new every day here.

[foxl]

Originally Posted by rak1978

I was put on a basal and bolus immediately upon diagnosis.
That's an interesting question though. I've never heard of giving one without the other. I learn something new every day here.

I was surprised to hear of anyone recommending basal-only, and letting your pancreas do the bolus, but apparently some do.

[Grunch]

I think bolus only makes sense cause the pancreas could be able to take care of basal. But if it can't even do that how can you expect the pancreas to bolus? Seems like a bad idea to me.

[foxl]

Originally Posted by Grunch

I think bolus only makes sense cause the pancreas could be able to take care of basal. But if it can't even do that how can you expect the pancreas to bolus? Seems like a bad idea to me.

My thinking, too, but apparently if you do not require basal out of it, it gets some rest ... !?

[rak1978]

Maybe and only if you ate ZERO carbs this would work?
I need a higher basal and not as much bolus when I cut the carbs.

[foxl]

Originally Posted by rak1978

Maybe and only if you ate ZERO carbs this would work?
I need a higher basal and not as much bolus when I cut the carbs.

hmmm ... might depend on just how much IR you have -- ie, your liver spewing glucose would lead to higher basal needs?

Any guesses on the physiology of that?

[Subby]

I'm thinking the basal only approach, may well be an idealogical hangover from basal-only approaches of type 2. After all, type 1.5s may be coming from an incorrect type 2 diagnosis, and the doc may not quite be wrapping their head around it, and may be thinking along type 2 approaches.

Just pure conjecture.

In the end, being someone as involved as you are, Linda, it's all good, it's about having choices. You can try one or try the other if it's on the books, if it doesn't work you can switch or go full intensive.

I must admit that your problems with variable fasting, suggests basal in the mix no matter what, to me. Then again you could try bolus and see if this resting concept, helps with your basal abilities...

[foxl]

Originally Posted by Subby

I'm thinking the basal only approach, may well be an idealogical hangover from basal-only approaches of type 2. After all, type 1.5s may be coming from an incorrect type 2 diagnosis, and the doc may not quite be wrapping their head around it, and may be thinking along type 2 approaches.

Just pure conjecture.

In the end, being someone as involved as you are, Linda, it's all good, it's about having choices. You can try one or try the other if it's on the books, if it doesn't work you can switch or go full intensive.

I must admit that your problems with variable fasting, suggests basal in the mix no matter what, to me. Then again you could try bolus and see if this resting concept, helps with your basal abilities...

knew you'd have some ideas to contribute! And I will hang onto them ... thanks!

[rak1978]

Originally Posted by foxl

hmmm ... might depend on just how much IR you have -- ie, your liver spewing glucose would lead to higher basal needs?

Any guesses on the physiology of that?

Well, my theory is that it has to do with the dawn phenomenon.
When I bolus at breakfast time, that probably covers carbs as well as the DP. When I eat no carbs, I don't bolus and then the dp is a problem. I probably should just bolus regardless of carbs with breakfast to cover that....maybe then my basal settings would be fine? Seems like I have some experimenting to do.
Just thinking out loud...didn't mean to hijack the thread with my personal experiences.

[soso]

I started on bolus only..as that is the only time my bg was high at first. I do believe the pancreas getting a break helps to spin the honeymoon out and even though it is only anecdotal evidence that has been the case with me...

I also know of a lot of cases where Drs start the patient on Lantus only as a way of keeping the sugars a bit more in line.. though this is usually with T2 I think... it def would not work with me. I think one of the reasons for the Lantus only approach or maybe mixed insulins is that one shot a day is not so scary for the patient who dreads going on it. Easing them in gently perhaps?

Anyway, IMO it was the way to go and has worked very well for me.

Linda, just curious, but at what numbers/level would you consider adding insulin?

[foxl]

Originally Posted by soso

I started on bolus only..as that is the only time my bg was high at first. I do believe the pancreas getting a break helps to spin the honeymoon out and even though it is only anecdotal evidence that has been the case with me...

I also know of a lot of cases where Drs start the patient on Lantus only as a way of keeping the sugars a bit more in line.. though this is usually with T2 I think... it def would not work with me. I think one of the reasons for the Lantus only approach or maybe mixed insulins is that one shot a day is not so scary for the patient who dreads going on it. Easing them in gently perhaps?

Anyway, IMO it was the way to go and has worked very well for me.

Linda, just curious, but at what numbers/level would you consider adding insulin?

Soso, I do not KNOW! I have an Endo appt. end of Aug and am looking to her recommendations. I may be adding it now, but frankly I do not know ... my numbers are really quite good right now, I hate to mess with a good thing, but if there is an advantage to using low-dose insulin, for preserving beta cell mass, I think I should, And then, I do not have much flexibility in my diet. But then I debate about unnecessary insulin and feeding it, and weight gain ... URGH.

[Subby]

Originally Posted by foxl

But then I debate about unnecessary insulin and feeding it, and weight gain ... URGH.

Don't forget insulin doses vary wildly. The typical type one is in the realms of 20 - 40 units TDD. I say typical extremely loosely. The Walsh book you have will have a table of expected insulin use. It's interesting to look at, then you can go and throw it out the window when it comes to the real world and anything but vanilla type 1s with little resistance. (Ok, so there might be a consideration for type 2s, can't remember)

These are extremely rough illustrations, no accuracy intended. More a sense of scale.

A highly resistant type 2 might take 200 or 300. A pretty resistant type 1 (me) I take about 80 on a relatively low carb diet. Or, really heavily resistant type 1, back up towards 200.

Some LADAs I've seen wanting a boost to their natural abilities, have started on doses like 5 or 10units long acting. Maybe a few units for dinner bolus. That kind of thing. Maybe a TDD of 15 or 20.

I'm just thinking, the weight gain argument might be a bit of a blind, if you find you benefit nicely from doses on the lower scale like that and are not feeding the insulin (which I would take for granted, being firmly low carb that you are). Feeding occurs from things like sticking to set doses, not adapting or modifying.

[foxl]

Thanks Subby ... hope you are right, in my case! I'd hate to gain back those 30 lb ...

[zoelula]

I was worried about weight gain as well, Linda. (It's in my nature to worry about it!). It made sense that I was losing protein in my urine when I was high and that when I was down to normal I would be absorbing all those calories. But I am on a fairly low dose of insulin, and even when my TSH crept over 5 at one point my weight has stayed the same.