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oblivious

How low can you go with just basal?

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oblivious

As the body has a function that dumps glucose in the blood in the event that we get hypos, I wonder how this works if you are just taking basal?

 

I know that if you are taking fast acting insulin you might get a hypo from the fast drop in BG. But what if you are just taking the slow acting insulin?

Will the body(liver) have enough time to adjust to the falling BG, or are you still in risk of dropping below 3 mmol/l?

 

Is dosage a factor in this?

I am just on 16 units now, which is not a lot it seems..

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TX_Clint

Too much basal is still risking deadly results and the dosage danger level is dependent on too many variables to know how much is too much. Every person is different. It is important to adjust basal insulin levels slowly to see what your body's response is. When I was using a basal I had to wait a couple of days between dosage changes to get a stable indication of whether to change my dosage. 

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JohnSchroeder

Relying on liver dumps to prevent hypos seems like a bad idea to me.  Yeah, the liver does that... but it will probably run outta juice eventually.

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JohnSchroeder

Thinking a bit more.. at least in my experience, the liver doesn't prevent hypos so much as potentially kicks in once you already have one.

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NoraWI

As the body has a function that dumps glucose in the blood in the event that we get hypos, I wonder how this works if you are just taking basal?

 

I know that if you are taking fast acting insulin you might get a hypo from the fast drop in BG. But what if you are just taking the slow acting insulin?

Will the body(liver) have enough time to adjust to the falling BG, or are you still in risk of dropping below 3 mmol/l?

 

Is dosage a factor in this?

I am just on 16 units now, which is not a lot it seems..

Sixteen units of Toujeo is equivalent to 48 units of Lantus since Toujeo IS Lantus x 3. You have to be careful in communicating that. You are taking a substantial amount of basal. Can't answer your question as I am pumping Novolog.

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oblivious

Sixteen units of Toujeo is equivalent to 48 units of Lantus since Toujeo IS Lantus x 3. You have to be careful in communicating that. You are taking a substantial amount of basal. Can't answer your question as I am pumping Novolog.

 

 

I have read that it's not exactly times 3... the absorption rate is different making it more like a 2.5 or so to 1. The following is a good reference.

 

http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/000309/WC500047935.pdf

 

Actually, it is just more concentrated than Lantus is. 1 unit is 1 unit, just like 1 lbs of feathers weighs the same as 1 lbs of iron.

"International Unit" is a standard reference to how much it takes to have an effect, so 1 unit of Lantus has the same effect as 1 unit of Toujeo.

You just use less fluid with Toujeo, that`s all. That and it lasts for 36 hours, instead of 24 hours like Lantus.

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Hammer

It's my understanding that your liver doesn't release more glucose to overcome a hypo.  If that were the case, then anyone who had high glucose levels, then tried to lower them and had a false hypo, would have their liver release more glucose to maintain that high glucose level, so you'd never be able to get your fasting glucose levels down to a normal level.  Your body sees a false hypo the exact same as it sees an actual hypo, so having your liver release more glucose to overcome a false hypo would be counter productive.

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NoraWI

Actually, it is just more concentrated than Lantus is. 1 unit is 1 unit, just like 1 lbs of feathers weighs the same as 1 lbs of iron.

"International Unit" is a standard reference to how much it takes to have an effect, so 1 unit of Lantus has the same effect as 1 unit of Toujeo.

You just use less fluid with Toujeo, that`s all. That and it lasts for 36 hours, instead of 24 hours like Lantus.

Toujeo has 300 international units per each ml. Lantus has 100 international units per each ml. Therefore, Toujeo is 3 times more concentrated than Lantus. Sixteen units of Toujeo is equivalent to 16 x 3 of Lantus. Yes, the volume is smaller for this more concentrated insulin. But it is NOT equivalent to the same amount of Lantus. And Toujeo lasts longer because you are taking a higher dose of it.

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oblivious

Toujeo has 300 international units per each ml. Lantus has 100 international units per each ml. Therefore, Toujeo is 3 times more concentrated than Lantus. Sixteen units of Toujeo is equivalent to 16 x 3 of Lantus. Yes, the volume is smaller for this more concentrated insulin. But it is NOT equivalent to the same amount of Lantus. And Toujeo lasts longer because you are taking a higher dose of it.

You are looking at this the wrong way. Yes Toujeo has the 450 pen and is 3 times stronger than Lantus, but the international unit measure gives us a way to see how much Toujeo you need to get the equivalent effect as Lantus (or other insulin). So units does not tell you how much fluid you push out of the pen, it tells you how many working units you are taking out.

That is why the Toujeo pen can be smaller with the same amount of doses as a Lantus pen.

 

So instead of multiplying the amount of units you take from Toujeo to see how much that would equate in Lantus units, you divide the amount of ml Lantus you need to get for example 100 IU by three to see what the amount of ml Toujeo that would equate to in IU.

100 IU Lantus is has the same effect as 100 IU of Toujeo, but if you needed 10 ml of Lantus to get 100 IU, you would only need 3,3 ml of Toujeo to get 100 IU.

 

IU is an effect measurement, not a quantity measurement.

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oblivious

It's my understanding that your liver doesn't release more glucose to overcome a hypo. If that were the case, then anyone who had high glucose levels, then tried to lower them and had a false hypo, would have their liver release more glucose to maintain that high glucose level, so you'd never be able to get your fasting glucose levels down to a normal level. Your body sees a false hypo the exact same as it sees an actual hypo, so having your liver release more glucose to overcome a false hypo would be counter productive.

My nurse on my diabetes team explained it pretty good.

Your body does increase BG to deal with a hypo, but it also shuts of insulin production at the same time.

 

So when you get a hypo from taking a bolus, you eat carbs and since the bolus normally works for 3 hours you only get the one hypo.

 

When you are on basal and get a hypo, you eat carbs at get BG up, but you will still have insulin floating around so you are still in danger of another hypo.

 

There is a lower risk of getting hypos from basal though since it is much slower. But since the insulin is floating around all the time, the body can't autocorrect the same way as with normal people.

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TX_Clint

Did anyone even read the paper I referenced?

 

Switch between insulin glargine 100 units/ml and Toujeo

Insulin glargine 100 units/ml and Toujeo are not bioequivalent and are not directly interchangeable. - When switching from insulin glargine 100 units/ml to Toujeo, this can be done on a unit-to-unit basis, but a higher Toujeo dose (approximately 10-18%) may be needed to achieve target ranges for plasma glucose levels. - When switching from Toujeo to insulin glargine 100 units/ml, the dose should be reduced (approximately by 20%) to reduce the risk of hypoglycaemia.

 

Lantus is insulin glargine.

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oblivious

Did anyone even read the paper I referenced?

 

Switch between insulin glargine 100 units/ml and Toujeo

Insulin glargine 100 units/ml and Toujeo are not bioequivalent and are not directly interchangeable. - When switching from insulin glargine 100 units/ml to Toujeo, this can be done on a unit-to-unit basis, but a higher Toujeo dose (approximately 10-18%) may be needed to achieve target ranges for plasma glucose levels. - When switching from Toujeo to insulin glargine 100 units/ml, the dose should be reduced (approximately by 20%) to reduce the risk of hypoglycaemia.

 

Lantus is insulin glargine.

 

I wonder if this takes in to consideration the stacking effect Toujeo has.

It would be interesting to see how this is in practice for someone going from Lantus to Toujeo.

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Hammer

Just in case you still don`t agree with what I am saying, they state it on their website.

https://www.toujeo.com/about-toujeo

 

"No conversion needed

One unit of Toujeo® has the same amount of insulin as one unit of Lantus® (insulin glargine injection) 100 Units/mL."

Thanks for the link!  I think the reason that people are getting confused is because of the term "unit".  I unit of Lantus is physically larger than one unit of Toujeo.  Looking at the link, I can understand now why one unit of Lantus is the same as one unit of Toujeo.  To add to the confusion, there are 100 units of insulin in one ml of Lantus, and 300 units of insulin per ml in Toujeo, but those 300 units in one ml are not the same thing as one of the units that the Toujeo pen ejects.

 

post-8201-0-97875600-1450309120_thumb.jpg

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Hammer

As for how low can you go with just basal insulin, well, when I was up to 156 units of Lantus every night, then I lost weight, those 156 units were too much, so I had to decrease my dose, but I wasn't decreasing it fast enough, so I was having frequent lows....like lows in the 30's.  If I were to take that same 156 units today, it would kill me, so in your case, as was mentioned, it's best to increase your dose slowly until you get the BG levels you want.  Oh, and keep some glucose tablets close by in case you do go low.

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rzrbks

Point: The First; You should never walk out the door of your dwelling without Glucose tabs or an excellent equivalent. I cannot count the times over the last 15 years I has saved my posterior by having Tabs in pocket, briefcase, glove box/ glove compartment, golf bag, gym bag --- whatever.             DON'T LEAVE HOME WITHOUT IT.

 

Point: The Second; As a very wise member, of some standing here,has pointed out on many occasions, keeping careful track Basal/Bolus will protect you from the Mysterious and Irritating effects of Saturn's Moons. Today, everything was nearly perfect, tomorrow, did everything the same and Viola!! ( or as the French say) Voila!!  Catastrophe Unmitigated. Test! TEst! TESt! TEST!

 

Point: The Third;  I don't know about you, but while I find Basil important for Sausage and Pasghetti, I often grow tired of it in too many other things.

 

I think that will be my last comment on Basil vs Bowl-us for a while.

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TommyC1

My basal works very well with my normal level of exercise.

On days when I get a lot more exercise, and didn't cut back my basal enough, I can go quite low.

I take care to eat proactively on those days so I can't tell you how low they could go.

I'd just as soon not find out.

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jwags

What type of MODY are you? MODY and LADA are not the same thing. LADA is Type 1 and MODY is a genetic form of diabetes which interferes with the Insulin signaling. Anyone on insulin needs to be aware of hypos.

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ant hill

I might just Try just the Basel for 50 Hours without eating, Yes I will just Fast!!! I am sure that the Bolus helps in some way?

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