FUDiabetes

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

basal

#41

From an MDI point of view:
I too “run” a slightly higher basal. My basal tests show that I should taking 40u of Tresiba/day.

I take 44u because I like to eat. It allows me to have a bite sized Snickers bar, or a Kind bar, or eat an apple any time I want it without worrying about bolusing.

It makes me feel Unlimited!


#42

Yes.

And yes… I get this now. I didn’t understand it before and was resistant to the idea—that you could feel unlimited because of feeling like you had a freedom to make a variety of food choices. But I think I’m starting to understand that having that freedom doesn’t change whether or not I’d ever make the choice. There are still lots of foods that aren’t a good fit for me. But I’d like to take Diabetes back off the list of reasons why they’re not. Over the last couple of days I’ve begun to make better snack choices… I just don’t think it’s a coincidence.


#43

So doing this with Tresiba, how do you not end up low overnight? Do you go to bed higher? Or does your dawn phenomenon take care of that for you? When I end up over-basaled, I inevitably end up with middle of the night lows or needing to start the night off high-ish before bed.


#44

And just to make sure there’s no misunderstanding, @TravelingOn and @T1Allison, I am not bailing on you guys with the food stuff. I still don’t think you have to be able to eat bad things to be unlimited. I think it’s only been in the last couple of days that I experienced, in running that higher basal, a kind of freedom I’m not used to feeling. It’s the feeling of freedom of choice I’m responding to… I *still * can’t eat a frickin cookie, but that’s more a personal problem than a diabetes problem per se…


#45

I have to turn down the basals at night. I wouldn’t choose to run a higher nighttime basal for that exact reason.


#46

@cardamom I usually have a bedtime snack to bring me up to 140 or so. I seem to have the opposite of dawn phenomenon because if I’m higher when I wake up it goes down when I get up.


#47

The problem, of course, is that there may be times when eating that extra food is not convenient. Like when you’re asleep, or involved with your family or something at work, etc. I guess if you have a CGM alarm to remind you to eat, then that isn’t a problem. But if you’re checking your BG manually it is easier to forget (or get interested in something) and go low simply because your mind is involved with things other than eating.

Running with a basal higher than you need is sometimes called “feeding your insulin” and isn’t really anything new or complicated. It was the only way we had of treating diabetes back when I was diagnosed and prescribed a single injection a day of animal-source NPH. I had no choice but to eat based on where my BG was at the time. Transitioning to MDI, and later once improved analog basal insulins were available getting basal set correctly, was seen by me as a substantial improvement.


#48

@jag1 Having been diagnosed 48 years ago I remember well of having to eat to my insulin. This is really not like that.

A basal adjustment of .25u is not going to drive me low for quite some time. It’s just going to give me a cushion to eat 10g carbs without bolusing. And I guarantee you that in the next several hours I’ll want to eat something.

A CGM makes it much easier, but because it’s such a small amount of extra insulin being delivered slowly, it is possible to do with finger sticks.

Tresiba also makes it easier because for me it is very level and consistent. It would be much harder to do with something like Lantus.

Plus, I’m retired and lead a very uncomplicated life :wink:


#49

I don’t, and this that @jag1 describes below is my life, but it still works well. I just have to think less about whether or not to do insulin to cover those carbs. My mornings are crazy, but my line has been nearly flat the last few mornings because I know I have that insulin working. No spikes with my coffee, and I threw in a banana on my way to volunteer (knowing that 2nd graders know how to drop my BG more efficiently than my insulin does).

That’s me, jag1. It still works well. I had pancakes for lunch (with sugar free syrup) and peaked at a 180. This approach is helping me to contain the spike. If I need something a little later, I will be happy to grab a little snack. I won’t need a meal to make up the difference.


#50

I wonder if this is the same thing though. It sounds from what you are describing that in your case your basal may be set correctly, and not too high? The sign of a basal set to high is more what Doc is describing - that his BG is always trending down, and that he needs/likes minor adjustments that keep him in range. Looking at pre and post meal results not the best way to judge basal rate - that is more an indication of your bolus amount. If your basal is too high then you will need to eat something with carb before dinner tonight. Or, perhaps more important, you will wake up with a BG quite a bit lower than you go to sleep with.

My experience with a basal set too high is when I am travelling to a foreign country. As a tourist there are always new things to see and free time to see it, so I’m always on the move. This leads to unexpected lows that I need to bump up repeatedly. It is kind of nice at first since I’m interested in trying the new foods there anyway, but the need to keep feeding gets tiresome (walking around a city is great, but climbing a volcano not so much). I always need to adjust my basal down for the duration of my trip. I’ve measured needing a 30% or so reduction in basal in those circumstances, so more than Doc is describing.


#51

Not a bad conclusion, but I’ll tell you why I call it high… When I first started on the Levemir, I started at 13 units in the morning, 6-7 in the late afternoon, and another 7 at bedtime. When I came off of Auto Mode this last time around, my blood sugar just ran high for a couple of days, and Eric helped me adjust my basals to counter it. I moved to 19, 8, and 8 and haven’t gone back. It’s definitely more than I’ve had in years… ever actually. And I’ve tested those other rates, and they are right. There are times I need the extra insulin (like after coffee and after things like pancakes), and then there are times I need to go for a snack. It’s an insulin-heavy routine, and it really is how @docslotnick is describing. It’s not that it’s driving my blood sugar down, but it feels like I’m riding the wave…

Doclotsnick was doing just fine describing it. I should’ve left that alone. :grin:

About this, I’m not so sure. I am finding that running a higher basal does seem to dull the post-meal spike. Maybe there’s something else at play here, but this is a pattern I’m seeing for sure. It’s the draw for me.

Yes. Check.

Yup. This is what @Thomas, @Eric, and @MM2 were all so kind to help me identify and fix. This would be an example of a bad basal rate that is too high.

I wouldn’t do this when traveling. Not until I settled in. Traveling, although always fun, is also stressful and full of unknowns. This wouldn’t be an ideal time to be trying out a rate that’s too high. Honestly, and this might be my old flawed thinking, I’d rather go with a conservative basal here and maybe run higher than I’d prefer than to push the extra insulin and sweat all over the locals and be scary. This might also be influenced by my recent travel experience where I had too much insulin, and it was like a scene out of Pulp Fiction. :thinking:


#52

@docslotnick, I also like to have my basal a bit high during the day when possible. But I can’t keep it high at night: I am sensitive to +/- 0.05U/hr. My daily basal is around 20U/day, so about 50% of your basal. your +4U/24 hours is about the same as +0.10/hr for me: that would require me to eat carbs every 2 hours, or more often, during the night. I think I am like @cardamom.


#53

Same, pretty much all around! And I generally don’t mind it too much to an extent, because excuses to eat delicious carbs, but I end up adjusting down (which given that I’m on Tresiba, takes a bit to achieve anyway). I would not do it that way without a CGM though!


#54

Thanks so much to everyone for the continued discussion!

I wasn’t able to accèss the forum for a few days and I truly appreciate all these responses; it is very interesting to see how we all deal with this and how it relates to our treatment decisions, and especially how these shared experiences can help us all to manage our disease. Forums such as these can be such a help when compared with (ahem) the Doctors office (if you catch my meaning!) :wink:

I hope to chime in during the next few days in more detail with some thoughts and anecdotes of my own, and I also hope these will be of help or interest to anyone who reads them.

Best regards to all!


#55

So far, after a few weeks, I’ve had to bring my basals up for a couple reasons. Omnipod is not going to do .05 increments below 1 unit as far as I can tell but otherwise it’s great so far! I think the abdomen sites are better for me anyway, arms and legs require more pre-bolus time, and I may have had too much scarring. No tubing, hiding- two things I like.

A couple more observations:

Post meal spikes for me have always been down to 2 things, maybe 3 or even more actually, but 2 that I can hopefully manage.

(I say hopefully because sometimes I’m using 4 different BG monitors to compare and CGM and they’re too often apart by 40 or more points! And this is acceptable within FDA guidelines? OMFG right? Another WTF moment…lol)

So the 2 or 3 things I’ve come to understand a bit are insulin to carb ratio and insulin sensitivity (which for me varies during the day) and also pre- bolus time (which for me is a must to avoid spikes and corrections) and also maybe the most important thing for my digestion:

Carbs are not simply Carbs. 15 OJ carbs are going boost my BG a lot faster than 15 carbs of Rye crackers or Cashews. (Yes I often eat 1/2 cup of cashews or more, sometimes with cranberries…)

Understanding simple carbs and complex carbs, and the lot in between, have been absolutely essential for me, although to be honest I still haven’t mastered it.

I can eat Pasta and Rice and have easy going in a balanced meal with lots of veggies and healthy protein, but really the only times I get spikes are related to foods I don’t know the glycemic index of,

…or if I haven’t done calculating properly , or if maybe my sight was old, or if it was a certain time of day, or I’d been stressed out, or… I could go on and on but I’ll spare everyone a few details Im sure we’ve all been through hundreds or thousands of times…!!!

So ultimately, for me, I don’t see boosting basal to eat more carbs as the right way to establish a proper basal rate, which I think needs to be done fasting.

And if I want to graze, so to speak, which I often do, I think combo/extended/square wave or whatever else it’s called might be a better option than boosting basal as its practically the same thing- feeding insulin.

To which I must add that the concept of “feeding insulin” brings a lot of scary memories involving siezures and trips to the emergency room and other horrors from 20-30 years ago!

Ultimately after so many years my true feeling is that minimising insulin usage is the best way to go about diabetes- and the curse of this disease is a mixed blessing in disguise:

It forces us to eat right and exercise, and there’s
nothing really wrong with that, although it is difficult when concidering many other things, especially one of the worst problems affecting too many of us (it really shouldn’t be affecting any of us at all!) ;

what I consider the evil of the health care industry that would profit at the expense of the health and well being of people who aren’t able to afford the proper health care.


#56

@gorf, you should be able to tune your basal by 0.05 unit increments if you wish to, even below 1U. My son does that all the time. What happens when you try to dial your basal below 1U/hr?

We occasionally compare readings too, and they can be quite off. But in general it is best to use a single meter for corrections, since otherwise you may end up correcting because you are using a different meter rather than because of BG changes.

That is true for us too. In fact, when my son has a high extended peak, we use protein, fat, and a small amount if low GI veggies. These are almost “free”!

I did not quite understand your thought here.


#57

I am a capitalist through and through but I absolutely agree with this.


#58

I don’t (purposely) do it when traveling - it is the traveling that does it to me. I start my travels using the same basal rate as I use at home. But because of a different, more active routine, my basal needs have changed, and leads to frequent minor lows that I need to keep bumping up. So it is the change in my routine that causes me to have too high a basal rate, which I reduce until I find my new “corrected” basal. Unfortunately the amount I need to reduce my normal basal is not predictable going in, and takes some adjustment. The point is that too high a basal rate may be fun for a while, but not something I want to continue because it forces me to correct my BG too many times when it is not convenient.


#59

I see this clearly at lunch time. Normally I eat sandwiches made from 100% whole wheat bread and these do not need a prebolus - if I prebolus I go low - so instead I inject when I’m ready to eat. But if I have white bread (pizza, burger, hotdog) I prebolus else I’ll go high before I come back down.

But of course this is about tuning your bolus, and unrelated to basal being too high or correct.


#60

I was wrong I meant thousands: .025 below 1 unit per hour!

  • thanks for catching this. I used to do .925 or .975 for example.

Along with the CGM, I do use one meter for corrections/calibration. I thought I mentioned I use different meters for comparison.

I think that bolus discussions are quite relevant when talking about using higher basal as a method for eating, at least as a comparison if not more.

I think that overall I don’t see a higher basal rate as a legitimate method to mimic a normal persons metabolism so to speak (as was suggested before) and since I haven’t found any scientific evidence to support this as anything advanced, it seems too risky to be running low on purpose. After all why not just bolus for carbs?

I think for me anyways it’s safer to use the technologies as intended, especially due to the fact that they are not always accurate.
That being said most of the problems I’ve had are directly down to my own “user error.”

Another thing I believe is important to mention is the relationship between BG and mood, and that in my experience the side effects of hyper and hypo glycemia are not limited to those states. Almost as if insulin itself is responsible for the way I feel at times, and that limiting its overall intake is important for not having different side effects.

So when we talk about “feeding insulin” and the BG swings of prior insulin therapies, that for many of us could be wildly dangerous, when compared to now- even they may not be quite as large or problematic, that the “feeding insulin” state is not a good state to be in for a variety of reasons. Maybe it’s my perception bias based on personal experience? I liken it to walking a tightrope rather than a smooth coasting on a bicycle if that makes any sense. If anyone cares to tell me otherwise I’d be more than happy to hear this! I just have a pretty negative association with “feeding insulin.”

Therefore I strongly believe its better to be closer to 120-150 rather than lower than 100. Or A1C 6.5-7. I’ve reversed several complications that started with these numbers, diet and exercise.

And being normal or free is not an option really. I think it’s a dangerous thing to tell ourselves that. We have a metabolic disease and it’s important to acknowledge the reality of it because if we don’t we can be a danger to ourselves and also society. It’s a huge burden and responsibility and it can depressing and overwhelming, it’s so much F’ing work all the time! But at the same time it’s manageable and forces us to be healthy in some ways.

Im certainly not perfect by any means! I’ll eat foods that I probably shouldn’t but it’s okay to do so from time to time.

Honestly I can see trying this higher basal as an experiment and finding out I like it! Good to keep an open mind. This disease forces me too!