Is There a Minimum Safe Basal Amount?

belyro · #1 (**permalink**) 12-24-2006, 09:29 PM

I am on a ridiculously low amount of Levemir. When I started on DF (2 months ago) I was on two shots of 6 units each per day. Now through some wonderful advice from some wonderful people on here, I've cut my Levemir dose in half and am having MUCH better control! (YAY!) Now I take 6 units at night, and that's all. However, I still come down more between meals than I'd like to. Yesterday I was 7.0ish two hours after lunch, and I kept dropping all afternoon until I hit the 3's well below supper time (even with snacks in between). I'm not convinced that my nighttime bloodsugars will be able to handle another decrease in Levemir, but I'm tempted to try.

So.......what I'm wondering is......is there a minimum "safe" basal dose? It seems absurd to go down to 4 or 5 units a day. That's all the basal I'd be on! I'm also on Humalog and take 6 units, 10 units, and 10 units respectively at breakfast, lunch and supper. (I eat about 150-200 carbs a day, but am thinking of cutting back, or at least moving into lower GI foods.)

If you have suggestions for how to keep it from dropping between meals other than taking less Levemir, I'm open to those, but what I really REALLY want to know if it's safe to take such a minimal amount of basal, or if I'm running the risk of having problems with ketones, etc.
Thanks!

Funnygrl · #2 (**permalink**) 12-24-2006, 09:41 PM

If your blood sugar is dropping like that, it means you are getting too much insulin. Cutting down too much will cause ketones, but what the safe amount of basal is, is the amount that you have good blood sugars at. If your blood sugars are in range, it means you are getting proper amounts of insulin, and shouldn't get ketones (at least not from that). I doubt ketones will be a problem, especially if you take decent meal boluses. You can try testing for ketones a few times, and if it is a problem, making try 2 doses a day again, but smaller amounts.

I didn't use any basal for about 2 months when I was first diagnosed, but I was honeymooning and my need for basal hit like a ton of bricks.

hadi_1975 · #3 (**permalink**) 12-25-2006, 02:22 AM

Theoretically basal dose is between 25-50% of total insulin dose in 24 hrs (for you it is 8-16 U) which is best taken at bedtime. I think you had better take less bolus at lunch and/or dinner depending on when you have most of the hypos. You can start with 2 U reduction and advance according to your BG results.

seacomp · #4 (**permalink**) 12-25-2006, 02:31 AM

Your bolus ratio (carbs to insulin units) is about 6 to 1 from your description. That's about the ratio I use, and I'm an insulin resistant type 2. It would seem likely that you are just bolusing too much for what you eat.

xMenace · #5 (**permalink**) 12-25-2006, 04:55 AM

The "THEORY" is your basals should keep you steady with no food intake. On an MDI it's often impossible to stay in range for a 24hr period, hence split dosing and possible extra bolusing to fill in the gaps.

The only way to tell is to pick a typical day with a decent BG and skip a meal. Test hourly. You should stay in range -- say 6-8. Skip only one meal a day. Repeat as necessary. Everything else is guesswork IMHO.

"We're all different"

Cyborg · #6 (**permalink**) 12-25-2006, 06:19 AM

You can lower your basal and not worry about ketones. As suggested, do some basal testing. Nothing like having daily lows...

belyro · #7 (**permalink**) 12-25-2006, 08:17 AM

Quote:

Originally Posted by seacomp

Your bolus ratio (carbs to insulin units) is about 6 to 1 from your description. That's about the ratio I use, and I'm an insulin resistant type 2. It would seem likely that you are just bolusing too much for what you eat.

But if I bolus less I'll go well above 10 after each meal. Trust me.

Cyborg · #8 (**permalink**) 12-25-2006, 08:53 AM

You may find you need to change your insulin to carb ratio(s) after adjusting your basal.

duck · #9 (**permalink**) 12-25-2006, 03:56 PM

Bethany, before you do that, try skipping lunch and the lunch bolus and check your sugars every half hour and see if they go up, down or stay the same. You *may* be bolusing too much "meal" insulin.

DanG · #10 (**permalink**) 12-25-2006, 04:17 PM

Quote:

Originally Posted by xMenace

The "THEORY" is your basals should keep you steady with no food intake. On an MDI it's often impossible to stay in range for a 24hr period, hence split dosing and possible extra bolusing to fill in the gaps.

The only way to tell is to pick a typical day with a decent BG and skip a meal. Test hourly. You should stay in range -- say 6-8. Skip only one meal a day. Repeat as necessary. Everything else is guesswork IMHO.

"We're all different"

Hmmm - I like this dialog.

I was started on lantus/humalog routine a couple years ago, after lente was no longer available. The initial lantus dosing was night time only. After reading here, I decided to start the split lantus and am okay, I think. I do 8 at night, 12 morning. I have no idea how flat lantus is (in my system - I like your sig line, xMenace "We're all different"), but I was endinging waaay too low in the morning with a full 20 each night.

After reading here about split lantus, I am trying that routine out. So far, so good, and xMenace notes here seems good. Someday I will do some meal skip to see how the basal is being used - flat or slight hill/whatever.

Thanks Bethany for this timely thread.

belyro · #11 (**permalink**) 12-26-2006, 10:21 AM

Quote:

Originally Posted by duck

Bethany, before you do that, try skipping lunch and the lunch bolus and check your sugars every half hour and see if they go up, down or stay the same. You *may* be bolusing too much "meal" insulin.

How CAN I be, though, Duck? Most days I still get up to 8 or 10 2 hours after a meal. If I bolus less, it's definitely going to go up higher. That was my problem in the first place....2 hours after breakfast I had to be at LEAST 15 or I'd be low before lunch. Then I cut my basal in half and ended up being able to be 8 two hours after breakfast (with more bolus to compensate for the lower basal) and about 4 by lunch. I'm happy with that, but my afternoons don't work so well. I was hoping if I reduced the bolus by one or two more units it would help. Now I have to be 10 or 12 2 hours after lunch....sometimes higher, depending on whether I'm running errands or just sitting on my butt at my desk. Really and truly, if I increase my meal boluses, it's definitely going to be above 10 two hours after a meal....and there are some people on this forum who think even THAT is too high.

I'm going to an appointment with my CDE later in January (and a dietician) so I'm hoping that will give me some ideas. My best bet may be trying a low GI diet, I think.

Stuboy · #12 (**permalink**) 12-26-2006, 10:45 AM

At the moment i'm takng a 7u shot every 12 hours, 9am and 9pm of lantus. It seems to keep me very steady without food, i go for 18 hours without eating sometimes (most weekends) and im absolutely FINE!

I imagine my basal u's will creep up as honeymoon ends

Also, i find that if i have too much lantus i get a stomping headache... like weeks ago when i was using the 2u dose pen, i upped it to 12u's (i hadn't split then) and i have a massive headache in the morning. then i split and had 6u's every 12 horus, all fine, a little high tho... to upped it to 7u's twice a day and it's perfect. YESTERDAY i took my morning 7 u's half asleep, and when i came to change my needle later, saw that the dial was on 5, so i thought i hadn't injected all of my morning dose, so i primed the rest of the 5... nothing came out, very confused, wound it back up to 5 and took what i thought i'd missed.. big mistake, massive head ache all day christmas day, today im fine cuz i dont have too much basal.

It's weird how we all react differently to basal's, too much too little, they all have tell tail signs i guess!

BlueSky · #13 (**permalink**) 12-26-2006, 10:50 AM

Quote:

Originally Posted by belyro

Quote:

Originally Posted by duck View Post
Bethany, before you do that, try skipping lunch and the lunch bolus and check your sugars every half hour and see if they go up, down or stay the same. You *may* be bolusing too much "meal" insulin

How CAN I be, though, Duck? .......

Bethany,

Have you actually done this test yet? I was very resistant to the idea before I first did it, mainly because my BG was unstable at the time. And I couldn't see how this would help. But there could be any number of confounding factors here. And speculating on what might happen only messes with your mind. Doing the basal test exercise will enable you to separately focus on basal and bolus insulin action. You could be surprised at what you find. And the exercise will definitely help you use the most approrpriate tactics.

grace girl · #14 (**permalink**) 12-26-2006, 11:10 AM

I think you need to do some basal tests to really know what you need to do. Doing the tests sucks, really, but what you learn from it is great. I would also add, though, that I'm not convinced that the tests are always 100% accurate when you're on mdi, as opposed to the pump. According to the guidelines the results of my tests say I'm taking too much basal, but I've found a system that's working for me and giving me the results I want.

I don't know what you're carb ratio's are, but what you're saying makes me think that perhaps you need to increase you're basal and decrease your carb ratios.
A few months ago they had me on a small amount of basal and a larger amount of bolus and I found it to be a major roller coaster....way too easy to go low after meals.

I've raised my basal to as high as I can stand it and lowered my carb ratio's as I've gone along. Over the last few weeks I'm at about 65% basal and 35%bolus....I've found that with the basal being the major player I've got more steady b/s....it's not as unpredictable as it was before. I've got one time a day when I'm prone to lows, as opposed to three or four, and I'm now beginning to figure out what's really causing these lows (it's all activity level for me. If I get really busy after lunch I have to watch out) so I have a better idea at least of when it will happen.

duck · #15 (**permalink**) 12-26-2006, 12:04 PM

Quote:

Originally Posted by belyro

How CAN I be, though, Duck? Most days I still get up to 8 or 10 2 hours after a meal. If I bolus less, it's definitely going to go up higher. That was my problem in the first place....2 hours after breakfast I had to be at LEAST 15 or I'd be low before lunch. Then I cut my basal in half and ended up being able to be 8 two hours after breakfast (with more bolus to compensate for the lower basal) and about 4 by lunch. I'm happy with that, but my afternoons don't work so well. I was hoping if I reduced the bolus by one or two more units it would help. Now I have to be 10 or 12 2 hours after lunch....sometimes higher, depending on whether I'm running errands or just sitting on my butt at my desk. Really and truly, if I increase my meal boluses, it's definitely going to be above 10 two hours after a meal....and there are some people on this forum who think even THAT is too high.

I'm going to an appointment with my CDE later in January (and a dietician) so I'm hoping that will give me some ideas. My best bet may be trying a low GI diet, I think.

Let me make sure I understand what your query is:

You take 6 U of Levemir at night...You eat breakfast, you bolus. But it's not your AM sugars you are worried about.

You eat Lunch, bolus. And even though you are 7 two hours later, without eating anything you continue to drop the rest of the afternoon, right?

What I am saying is, skip LUNCH--don't EAT. I know, it sucks. But you are meal bolusing for lunch, right? In theory, if you are not going to eat lunch, you don't need to bolus for it. If you skip lunch, you can get a better idea of whether your basal insulin is indeed too much in the late afternoon, or if maybe your bolus insulin lingers longer for you than the "typical" four hours. As it is, we have no idea which of the two are affecting your sugars to knock them down later in the afternoon...