FUDiabetes

Using a higher basal than we absolutely need: one more treatment option

basal

#1

So this is very, very interesting to me. I have heard this before but have never really had a good conversation about it. From what I understand, you’re not supposed to use your basal to cover your food, but… why not? I’m not asking to be difficult; I’m asking to understand. If a heavier basal for a period of time results in a lower BG, which makes light snacking (I’m a grazer, so this is my favorite) a requirement, why is this bad? Outside of the obvious, of course, that it will put me at greater risk for hypoglycemia.

I’ll just say that the alternative, with basals that will pass the tests comfortably, often leave me with blood sugars that jump easily. When I handle it this way, I find myself having to wait… to have a snack, to eat my soup, to drink my coffee… I’m just not fond of it, and I don’t always do that well. I had to bump up the basal recently, with Eric’s help, to accommodate for a couple of days of high blood sugars, and I was surprised to see how much I liked it even when my blood sugar returned to normal.

Long-winded. I know. This is just an interesting subject, and I’d love to hear thoughts.


Omnipod Musings
#2

Well, greater risk for hypoglycemia could be sufficient reason. But if not …

My understanding – and heck, I could be wrong – is that the basal meets the needs of the body in the absence of food. When you breathe, when your heart beats, when you move, when your eyes move, when you type, all that requires the burning of energy, which requires insulin. If you have more insulin than you need for those basic functions of being alive, then you crash.

Life, as you know all too well, is not regular and predictable. If you have a higher-than-needed basal to allow for food, what happens if something comes up that prevents you from eating? You have a problem. Which is why I find it easier and safer to bolus for food, even if I’m grazing and it means microboluses. Yes, it means time given over to carb counts and dose calculations, but for me that’s better than constantly feeding a basal that’s too high, which translates into eating when I don’t want to eat and also gaining weight.

Yes, the waiting can be a pain, and I don’t always do it that well either, especially in the morning. But when I do wait, and see the much better results, it kinda spurs me on to do it more often.

When you graze, do you carb count what you’re eating? Or do you just hope in the end it matches your basal?


Omnipod Musings
#3

What I’ve learned: basal rate is your fasting rate and bolus was for eating. Over the years I’ve also learned the formulas and technology aren’t 100% accurate for many different reasons, so I generally try to stay within the systems as prescribed, rather than introducing other variables.

I do adjust basal rates as a percentage mostly for exercise, although once a good level of fitness is achieved basal adjustments are less, and glucose tabs are my friend! And occasionally other situations like illness or travel, but I bolus for eating and correction.

I don’t adjust basal for eating as that’s not what it was désignéd for as far as I understand it. So
“feeding insulin” as it were is not a goal of mine. Being hypoglycemic or nearly so has too many side effects for my taste.

And the wait time is absolutely essential when bolusing for me! Minimum of 15 minutes depending where my BG is.


#4

Nicky is doing something that is a somewhat unconventional and advanced technique. It is actually much closer to the way a non-diabetic’s body goes through the day. Rather than having the automatic glucagon response that is present in the non-diabetic’s body, she is using food. But it essentially works in a way that is very similar to what happens in the non-diabetic’s body - the constant counter-balance between insulin and glucagon. Or in this case, the counter-balance between basal insulin and exogenous carb sources.

It is not the conventional basic approach everyone talks about, bolus for food, and basal for maintenance of the body’s metabolic function. But I applaud her for trying something advanced like this. I look forward to hearing how it works for her.


#5

I don’t understand this, can you explain it in more detail? It’s sounds quite interesting.

From what I read, it seemed like setting a basal to create a near-hypo state where you could eat more without bolusing, which I dont see as a good idea, as it’s possibly dangerous to be hypo and feeding insulin. I also don’t understand the comparison- how is this similar to a non-diabetic?

It also seems that feeding a basal might mess up all the other calculations used when bolusing for meals, insulin on board, and carb ratio?


#6

I think the issue for us is that having a higher basal consistently means lower spikes, even if we’re super careful with bolusing and carb counting. There are certain meals that are simply no-gos with a “perfect” basal (though often for us it’s in between – there’s either too high or too low). With a slightly higher basal we can have a smooth landing and stay in range for the whole meal. I don’t know if that’s the same for bigger people though; I suspect that it has to do with the ratio of basal/carbF. Samson has carb ratios that are probably not far from what some adults may have (1:19 in the morning, 1:23 lunch), but his basal rates can be tiny (0.075 at some points). So that extra basal can cover a multitude of bolus sins and even though it can lead to crashes, so can his going high and then us having to bring that down. In the end we do try to have the right basal but if I had to err, I would err on the side of a slightly higher basal.


#7

I’ll second that. I’m intrigued.


#8

#9

I think I have my basal set about right, but on work days, when I like to eat toast and half a banana for breakfast, I hike my basal up an hour and a half or so before breakfast, and it helps immensely! I don’t program it to my basal profile because I don’t eat at the same time every day, but I love having it as an option. Toast for breakfast doesn’t work out nearly as well without it!


#10

Of course as soon as I post this my post-breakfast bg starts climbing higher and higher, lol. Maybe I should have said it USUALLY helps immensely:) I jinxed myself.


#11

I’m kind of joking and kind of being dead serious. I was sure what I was doing was inappropriate but honestly not sure why. I feel more normal pushing the extra basal and just treating occasional dips. @Beacher, I’m carb counting, yes. For the most part. There’s some approximating in there, but I have an idea about how much I need and am attempting to match it with the right snack. It fits my lifestyle—at the moment. It means I do one bolus in the morning for my coffee and then just relax and drink my 2 cups. It means my salad doesn’t send me to a 200. It’s not without some risk, obviously, but as @T1Allison mentioned, there are times when it’s not ideal. Its cruise control, which doesn’t let me off the hook from my driving responsibilities like steering, braking, or even paying attention, but it lightens the load for a bit.

I’d like to hang around and take questions, but there’s floating throughout the rest of my day to be done, and I must be off for it immediately.


#12

Yesterday I had to best day of just a tad extra basal. I got two free candy bars out of that. No major spikes and no lows. It was amazing.

When I can get the right amount of a tad extra basal, it’s heaven. But given that my basals fluctuate enough already day to day, setting the correct extra percentage is the toughest part. Too little, post-meal spikes and I get stuck high. Too much, then exercise of any kind sends me low too quick for my comfort level.

As with all things D, it is a balancing act with a ton of guess and check.


#13

You don’t do it to replace bolus for a full meal. And you don’t do it so that you run low all of the time.

It is done at a level that may require you to have an occasional potato chip or a Gummibär from time-to-time.

Glucose is the primary energy source of the body. In the non-D, the balance of glucose levels is done with both insulin and glucagon.

Glucagon is produced by alpha cells in the pancreas. When glucagon is released into the blood, it increases BG by promoting glycogenolysis and gluconeogenesis in the liver.

Since diabetics do not have this hormonal response, they reduce their basal insulin and primarily feed at meals. They do not have the same continual back-and-forth of insulin and glycogen.

A stronger basal and occasional carb feeding in small amounts imitates the same back-and-forth of insulin and glucagon.

Non-diabetics do not completely shut down their alpha cells between meals and have no glucose release! If you only take enough basal to cover your body and have no glucose being supplied between meals, that is not similar to the function of the non-diabetic and their supply of liver glycogen that is fed to them during the day.

It takes discipline to not over-eat, and also the discipline to stay on top of your BG numbers. Nicky is very tuned in to her BG numbers, and she is able to have an occasional grazing type of food snack, and also likes it. So it makes sense.

Imagine trying to bolus every time you wanted a single potato chip, several times between lunch and dinner. Wouldn’t that be silly?


#14

Welcome to the Dark Side.
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#15

I don’t know. Would it? If you know the carb value of a single potato chip, it’s easy enough to do a tiny bolus. But I could see how constantly doing so would be a pain if you were a grazer. I’m not, I only eat at my two or three mealtimes, and the rare time I do have something small in between, it’s no big deal to me to do a small bolus. So I’m guessing running a higher basal would be dumb for me. But the thinking behind it makes perfect sense.


#16

I think the difference comes down to a) are you doing the bolus for yourself on something easy and handheld, like a phone or a pod, or are you having to wrestle someone else down to do a bolus? b) do you like/feel proficient in carb-counting or do you find it annoying c) d you like to graze or is having to eat all the time a pain in the butt – or do you have issues with weight where grazing leads to gain? and d) How often can you be momentarily interrupted to deal with your blood sugar with a slightly high basal versus a need to bolus for every food that passes your lips.

For us, high basal winds up being easier, given the difficulty of giving boluses to a preschooler, the annoyance of having to carb-count on the fly for weird portion sizes, the fact that my son hates being interrupted for insulin dosing but doesn’t mind if it means “treats” and the tendency for little ones to snack a lot anyway. Also I find when he has a higher basal rate we wind up using less insulin. Don’t ask me why but that’s the trend I see.


#17

also for us we *can’t bolus for some of the portions he eats; some would require less than 0.1 unit of insulin, but it might still bump him up a bit…

Or let’s say he eats 3 little snack portions. With a 0.1 unit bolus increment, we can’t actually bolus for exactly what he should get; it rounds down or up. Add up that rounding error and you can get a lot of imprecision even with meticulous carb-counting.


#18

That was a very good summary and personal account your experience with it. Thanks.


#19

Makes sense! Thanks for making it clear.


#20

Me, too.