FUDiabetes

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

basal

#21

Is this really different than what I’m already doing? I’m using various basal adjustments as a percentage increase or decrease from my fasting rate, and also extended bolus.

A potato chip is 1 carb, which is not too hard for me to figure out at my age, weight and metabolism.

Maybe boosting the basal could also be described as a Snacking rate?

Finally is it true that Type1’s do not produce glucagon? I hadn’t heard this before.

I’ve also had success with snacking on nuts and seeds which don’t require much insulin as potato chips for me.


#22

I have to admit, I’ve been doing this for years. And most recently, my pump died, and I got a replacement. I was lazy and set up a basal with one rate for daytime, one for overnight. Before that I had 6 or 7 intervals. Total basal now 12, compared to 11.3.

Since I have CGMS, and feel lows pretty well, I plan on mini snacks throughout the day when trending low. The hardest part is over snacking, but then I just give bolus when I know I ate too much.


#23

I absolutely appreciate the anecdotal evidence of all diabetics, which can be extremely helpful.
We all know the prevailing wisdom isn’t always as accurate as it could or should be!

At the same time I’m naturally a sceptic, and I would like to see some scientific data to back up these claims.

For example, in regards to the concept of imitating the non-diabetic in this “advanced” treatment method.

Do we know the non-diabetic metabolism uses more basal and less bolus, which appears as part of the comparison?

Also how is glucose, a carbohydrate, simulating glucagon, a hormone, and glycogen? As I understand it, glucagon is not absent in all Type 1 patients. And I can stimulâte glycogen synthesis by exercising, simultaneously increasing insulin sensitivity, gaining fitness and reducing overall basal.

The benefits of exercise- cardiovascular and blood vessel health, can also prevent complications and improve mood and quality of life and I find exercise to be essential as a diabetic.

And finally what is the goal? Reduction of insulin usage, A1C, post meal spikes, snacking all day? (All of which are good!)

I’d really just like to see some evidence. I’m hesitant to try something I read online, especially after closing in on 40 years of Diabetes technology and prescriptions that haven’t always worked as advertised.

Thanks to everyone!

-edited because typing on my phone is a PITA!


#24

Hi @gorf!

I’m not trying to ignore your post but need to ask an Omnipod question… I hope everyone will answer your post as well. I won’t attempt to answer anything beyond your question about the goal… For me, post meal spikes are a nuisance, and because I know I’m going to have them, I’m faced with a decision every time… Do I do my insulin and wait the 15-45 minutes and do it right? Or do I go ahead and eat and just not bother? This isn’t a tough decision because I’m unsure of the right answer; it’s a tough decision because I can’t plan for much of what I eat and am often very hungry by the time it’s available. I’ve got three sons, ages 5-14, and planning and organization aren’t what’s happening these days. If I dont do things right, I’m hitting 250-300. If I push a generally stronger basal, when I get hungry, I’ve already got that insulin working and can sometimes see no higher than a 175 for my post meal rise. The second goal is the ability to snack… yesterday I got some toast with breakfast. I heard @kpanda01 mention it, my blood sugar was right, and I decided to have a piece. I haven’t had toast in years. My mornings are a major struggle. However, with the more aggressive basal rate, I’m a flat line. If at any point I really decide I want to cut back on calories (I’m not much of a calorie watcher, but I do hear it works), then I would cut back on the basal. With this higher rate, I could not go for 4 hours without snacking. For now, I like being able to have an applesauce or Kind bar without having to plan my afternoon around it or without having to see a ridiculous score.

This is just more anecdotal evidence, which is not what you were looking for, but I wanted to answer your question about the goals. I absolutely agree it’s a mistake to try something you’ve read online without feeling satisfied you’ve heard adequate evidence. And I hope you don’t feel any pressure to try it at all… It’s just a discussion between diabetics over daily maintenance strategy. For me, it’s my favorite part of the site.


#25

I don’t know if that question could ever be answered. “Homemade” insulin in non-diabetics gets to take a different path than injected insulin in diabetics. We’re replicating a hormonal process without all of the advantages of the fully functioning human body. And if our stomachs dump faster than non-diabetics due to lack of amylin? or whatever it is, then I think our mechanisms are all different enough that an apples-to-apples comparison is impossible and somewhat unusable for our purposes.


#26

Same here. (Well, two sons, but the stuff about life, planning, spikes, extra basal is all the same.)


#27

Glucagon causes the liver to release glycogen, which is stored glucose. Ultimately glucagon causes glucose to be released into the blood.

Eating carbs puts glucose into the blood directly. It has the same end result as glucagon, which is glucose being put into the blood.


#28

Adding water to the mill :slight_smile: We also love to maintain a slightly higher basal than we need, in particular before meals: it makes turning the corner much easier, more timely and more certain, and makes difficult meals easier!

That, however, only applies for us during the day. At night, having to nibble multiple times is a pain in the neck because it requires staying awake all the way through, whereas if you are a litle high at night, you can wake up with the alarm, inject and go back to bed.

One more thought, though, very recent for us: we have been spending too much time low lately, and have had to use large quantities of sugar to come back from heavy peak corrections. When that is the case, given how many extra carbs we need to eat to stave off a low, we are a lot less enthusiastic about maintaining too high a basal.


#29

@Nickyghaleb, I’m curious about something. You mentioned applesauce or a kind bar as examples of snacks you can handle more easily with a strong basal running. Are you still blousing your “typical” amount for something like this, but not having to time it as precisely, or are you using less insulin, or…? I’m not phrasing my question well, but I’m curious how, specifically, the higher basal changes how you’d handle a snack. If I’m drifting low it seems like even a couple skittles is enough to flatten me out for a while, so I’m intrigued by your kind bar skills.


#30

That’s a great question… and I’m not sure exactly how to answer it. I think with the higher basals there’s just a general push downward of my blood sugar. I’m going to BUTCHER this very science-y and diabetic-y explanation, but I don’t even care. There’s just this heavier push downward. For the most part, I still do need full insulin for my snacks— a Kind bar is like 23 grams of carbs. I’d still do my full bolus for that, but that extra basal helps me prevent the big spike from it. It just means more carefree eating… and more feeling normal.

I can do preboluses. It’s not that I can’t, but they’re hard. My life has become so fast-paced and chaotic (not in a terrible way but in a fast-paced and chaotic way) that I’m regularly faced with the decision to wait to eat or just to eat. As most of what I’m doing isn’t planned, it’s like the food is there in front of me, and I’m tired, and someone’s yelling for me, and I’ve gotta head out the door to get someone else—- so it can be REALLY hard to make myself do the prebolus as sometimes I’m not even sure when I’ll make it back to the table. A 5 minute or even 10 minute prebolus is inadequate, and there is no sadness like the sadness I feel when my nice calm 95 climbs to a 245 because of a Kind bar. Or chips. Or a banana!! That one’s the worst!! I love bananas, and I now feel like they’re my archenemy. And they own me. Every frickin time.

I’ll put a picture in here in a second to show you my salad, zucchini and meat sauce, and chips tonight. The first slope was from where I forgot to change my pod before leaving the house. That was a disaster. I hit a 350 before turning around. But then you can see the rest of the evening, and I ate a BUNCH. I know one 2 hour clip is almost worthless, but it’s the same thing I see in the morning, and my mornings can really be a beast.

Anyway. You running yet? :smiley:


#31


#32

Clean landing, @Nickyghaleb!

I changed the title of the thread after a long discussion with @Eric, to reflect better the thought that this is one more tool in our treatment options, rather than a strategy to pick or not to pick.


#33

That’s perfect. Thank you!


#34

In my experience, this strategy tends to promote weight gain, in part because it drives appetite and mandates more regular eating. If someone is concerned at all about weight management, it’s probably not the best choice. Some folks are not though, and if I weren’t, maybe I would do it.


#35

Thanks for the explanation! I’ve been using a temp basal for breakfast for months with good success. I’ve been much more spikey over the past couple weeks than I’m accustomed to and am trying to figure it out. I may play around with this a bit more, at least on days when I know I want to snack a bit. I have also been considering using an increased temp basal all day on thanksgiving when I know I’ll be eating a ton anyway.


#36

Thanksgiving would be a wonderful time to try it out. I know I made it through Halloween with way better numbers than any Halloween before, and I don’t believe it to be coincidence. If you do mess around with it, please keep in mind all that’s been said about keeping safe— like making sure not to do it away from the house or when you might not be able to get to food. I will tell you that I’m not always sure how much I’m going to need to eat in order to compensate for the addition. This morning I had an extra cup of coffee and banana on my way out the door to volunteer and figured it would get me through until I got home again. I began to fall about 30 minutes later and needed a little more to stay up.


#37

Agreed. That was how I expressed it in my original comment— that a difference in basal seemed to be the difference in how much I needed to snack. Right now I’m comfortable with my weight and am using exercise to keep it under control. However, I will probably tweak basals during a few small pockets throughout the day because I’ve recognized exactly this— that I’m finding I need to eat even though I’m not hungry. Just as much as I hate seeing my excellent blood sugar climb to a 250 because of a small snack, I also hate putting down 600 calories only because I didn’t want to die. :smiley: It’s true there are times it’s a better fit.


#38

It’s probably been said elsewhere, but when I run extra basal I keep an eye on:

  1. activity level increases: extra basal will be amplified if I go from office work to busy home life, so I dial down accordingly
  2. hot showers: extra basal will drop me much faster than my usual shower induced basal drop

#39

A post was split to a new topic: Do you use showers for BG management?


#40

Just wanted to say this is my life! Afrezza has been saving my butt lately here (since I don’t have basal yet…ugh), and right now I’ve run out of Afrezza (another issue…seriously about to fire my doc), and my BG has been so messy using only Novolog, which ideally requires a 45 min prebolus. With two toddlers, it’s a nightmare.

This is a treatment strategy I will definitely try whenever I do get basal…and a pump…because I have to eat every 2-3 hrs due to another medical condition, and it’s a pain having to deal with that.