Basal bolus insulin balance

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Basal bolus insulin balance


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Old 11-05-2017, 11:59   #1
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Question Basal bolus insulin balance

Hi,
I have been a diabetic for the past 14 years and am presently on Glycomet GP2 Forte (Morning and night), Cardace am5 and Apidra insulin 12-16-12. I had used Lantus (10 units) a few months back but after observing very low pre-meal values stopped it completely. My A1C is generally 5.5-5.8. I still find low pre-meal values and occasional high postprandial values but not very dangerous. Is it common that people use Apidra (bolus insulin) without Lantus (basal insulin) like me or should I reduce my oral medication and start on Lantus? My food habits do not vary much and I regularly go for my morning walk for about 50 min., sometimes jogging also.

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Old 11-05-2017, 12:35   #2
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While I do not take insulin so have no direct experience with it, I have been reading posts here for several years from those who are on insulin.

Glycomet contains Glimepiride, a sulfonylurea drug, that stimulates the pancreas to produce insulin. So you are getting insulin from that - at an unpredictable level and rate, and also injecting insulin (Aprida). I would think that this combination would account for some of the highs and lows.

The basal insulin (Lantus) is most often used in T2s to regulate fasting blood sugar and keep it from rising so high. How has your fasting BG been without the Lantus?

The thing that impacts post-meal BG the most is the amount of carbohydrates in the meal. Most members here have learned that lowering the carbs to less than 50g a day (some even less) has a direct impact on the amount of insulin needed. Less insulin results in more stable BG.

Hopefully some of our T2s on insulin can give you more specific guidance.

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Old 11-05-2017, 12:50   #3
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Quote:
Originally Posted by VeeJay View Post
While I do not take insulin so have no direct experience with it, I have been reading posts here for several years from those who are on insulin.

Glycomet contains Glimepiride, a sulfonylurea drug, that stimulates the pancreas to produce insulin. So you are getting insulin from that - at an unpredictable level and rate, and also injecting insulin (Aprida). I would think that this combination would account for some of the highs and lows.

The basal insulin (Lantus) is most often used in T2s to regulate fasting blood sugar and keep it from rising so high. How has your fasting BG been without the Lantus?

The thing that impacts post-meal BG the most is the amount of carbohydrates in the meal. Most members here have learned that lowering the carbs to less than 50g a day (some even less) has a direct impact on the amount of insulin needed. Less insulin results in more stable BG.

Hopefully some of our T2s on insulin can give you more specific guidance.
My fasting in the morning is about 70-80, then before lunch it falls to 45-65, before dinner about 60-70. Overall all fasting values are on the lower side, that is why I am reluctant with Lantus. The post-lunch varies from 120-160 occasionally 180. It looks OK and manageable. But I only wonder bolus insulin without basal is common.

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Old 11-05-2017, 12:59   #4
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Quote:
Originally Posted by sasip_hyd View Post
My fasting in the morning is about 70-80, then before lunch it falls to 45-65, before dinner about 60-70. Overall all fasting values are on the lower side, that is why I am reluctant with Lantus. The post-lunch varies from 120-160 occasionally 180. It looks OK and manageable. But I only wonder bolus insulin without basal is common.
I would think it is the Glimepiride in the Glycomet that is causing your BG to go low. (I can't tell you if other T2s use bolus only.)

What do the numbers mean? "Apidra insulin 12-16-12" Are those the units you are taking for your three meals?

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Eat no grains
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Old 11-05-2017, 13:51   #5
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"Apidra insulin 12-16-12" are the units for three meals, breakfast, lunch and dinner. I don't generally take anything between.

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Old 11-05-2017, 16:49   #6
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Quote:
Originally Posted by sasip_hyd View Post
Hi,
I have been a diabetic for the past 14 years and am presently on Glycomet GP2 Forte (Morning and night), Cardace am5 and Apidra insulin 12-16-12. I had used Lantus (10 units) a few months back but after observing very low pre-meal values stopped it completely. My A1C is generally 5.5-5.8. I still find low pre-meal values and occasional high postprandial values but not very dangerous. Is it common that people use Apidra (bolus insulin) without Lantus (basal insulin) like me or should I reduce my oral medication and start on Lantus? My food habits do not vary much and I regularly go for my morning walk for about 50 min., sometimes jogging also.
Although low blood sugar can be more immediately dangerous than high blood sugar, high blood sugar can be dangerous. It does its damage over a longer period of time.

A1c is a number that reflects your what your average daily blood sugars have been doing for the last 3 or so months. That average includes highs and lows. A 5.5 A1c converts to about a 118 mg/dL (6.55mmol/L) daily average. That average can be from a low of 6.5 mmol/L and high of 6.6 mmol/L, it can also be from a low of 2.66 mmol/L and a high of 10.44 mmoll/L. Anything over 7.8 mmol/L is causing damage. You can read about this in a section of Bloodsugar101 called Research Connecting Organ Damage with Blood Sugar Level.

Reading Bloodsugar 101 is well worth the time in learning about diabetes.

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Old 11-14-2017, 21:33   #7
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At my most recent group diabetes education seminar, there were 3 people there who were type 2 who only took bolus insulin. This is because they don't have problems with their blood sugar EXCEPT after meals. Their overnight blood sugar is fine.

The diabetic educator said that they may see more of that because they can hook you up to a continuous blood sugar monitor for a week to see what is happening. What they do at the clinic is to first select those who had good morning blood sugar (90 or less and A1C<6.2). Then they used a continuous monitor for a week. Those who met certain guidelines then eliminated their Levemir/Lantus/Otherdiabetesdrug and then did the continuous monitor again (however, they did use Novolog bolus). Roughly 20% of that group are on bolus only now. I'm not even close to qualifying for this, so didn't ask for further information. I don't know if they continue to use metformin or not.

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Old 11-16-2017, 01:21   #8
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Quote:
Originally Posted by Bunjee View Post
At my most recent group diabetes education seminar, there were 3 people there who were type 2 who only took bolus insulin. This is because they don't have problems with their blood sugar EXCEPT after meals. Their overnight blood sugar is fine.

The diabetic educator said that they may see more of that because they can hook you up to a continuous blood sugar monitor for a week to see what is happening. What they do at the clinic is to first select those who had good morning blood sugar (90 or less and A1C<6.2). Then they used a continuous monitor for a week. Those who met certain guidelines then eliminated their Levemir/Lantus/Otherdiabetesdrug and then did the continuous monitor again (however, they did use Novolog bolus). Roughly 20% of that group are on bolus only now. I'm not even close to qualifying for this, so didn't ask for further information. I don't know if they continue to use metformin or not.
Thanks. I'll check this up again with my doctor.

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