Replies to This Discussion

Permalink Reply by Benjamin McLaughlin on March 12, 2012 at 7:04am

I guess I should say I did NOT take a bolus this morning and was 170 one hour after, 120 two hours after. Did not bolus yesterday any and had a high of 200, but that was after a traditional Sunday meal that I don't normally eat. I was trying to push the limit to see what my body could handle with no bolus. Obviously 100 carbs isn't it! But 200 still isn't that bad for no bolus and 100 carbs in a meal right?

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Permalink Reply by Tim on March 12, 2012 at 7:16am

In the honeymoon period some docs like to keep us injecting insulin (even just one unit) throughout. There's some theories (don't know of any proof) that this might extend the honeymoon period. I don't know if your doc has mentioned "the honeymoon" but that sure sounds like what you're doing right now.

And yes I agree 200 isn't so bad.

A low 3 to 4 hours after the meal, might not be obviously the bolus. If it was happening 1 or 2 hours after the meal it would be less ambiguous.

There's also the very real factor that small doses get absorbed more rapidly and a basal of only 3 units will get absorbed a lot more rapidly than the advertised Levemir 24 hour length. You are already splitting it AM/PM I see, maybe the next step is to split it 4 ways that might just be self-defeating because the more ways you split it, the faster it gets absorbed! Like Mickey with all the brooms in Fantasia!

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Permalink Reply by Benjamin McLaughlin on March 12, 2012 at 7:20am

Thanks so much for the fast reply! I knew they said it was bad to stop taking insulin, but I didn't know if that meant both basal and bolus or not. Didn't know if the taking basal was enough. So do you suggest to take the one unit, then just eat a snack a couple of hours post meal to keep from dipping into the 60s?

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Permalink Reply by Tim on March 12, 2012 at 7:30am

The one unit may even be psychological rather than real :-).

Carb counting and basal setting can be really hard during the honeymoon, because erratic insulin production can dominate any of the other factors and make the math seem pointless. I don't think the math is actually wrong, it's just hard to know in advance whether the pancreas will put out a couple units worth or not on its own and that completely dominates the small changes you'd see from a single unit.

I am personally tending to believing that the problem isn't the bolus, but is the very small doses of Levemir getting absorbed rapidly.

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Permalink Reply by HPNpilot on March 12, 2012 at 7:22am

Are you carb counting and adjusting the bolus to the carb intake ?
Sliding scale is an older/ less accurate approach. The basal/bolus approach
with the bolus adjusted for (a) carb count and (b) correction factor (if high or low)
is the preferred approach now.

Also, one thing I did when I was first diagnosed (about a year ago) and needed very little insulin was to get a pen that was capable of half-unit doses. This let me match the dose more closely to the need.

That way, you would have an option besides 1 unit or none.

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Permalink Reply by Benjamin McLaughlin on March 12, 2012 at 7:34am

Yes, being an athlete and into fitness and nutrition, I have been OCD about counting every single carb, subtracting the fiber, GI index, and any other possible factor. My wife (who has been absolutely amazing) says eating dinner with me now is like watching Einstein work a formula. I did all the calculations, where I thought I had an insulin to carb ration of 1:55 (9 total units of insulin, 1700 was my constant.) I have been a research maniac on all the latest everything. I also have been looking for .5 unit pens, but walgreens said they no longer can get the cartridges from their supplier. I have checked other pharmacies and they said the same. Unless they make a .5 unit disposable pen, which I haven't found if they do, I am out of luck. Even so, the novolog junior had to start at 1 unit, and thus defeating the purpose, because I would need .5 units. From my own research, I have thought my two options would be increasing carbs until I find my true ratio, or just not take the bolus, and see how many carbs I can eat and stay regular. I just don't like the fact of making myself eat more carbs just to cancel out insulin.

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Permalink Reply by MeganB on March 12, 2012 at 7:38am

I am in a very similar situation...I actually only bolus and do no basal. Have you tried that? I have no lows while exercising now which make me VERY happy!

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Permalink Reply by smileandnod on March 12, 2012 at 8:30am

Although the pens are more convenient, if you find that you really need the flexibility to dose in 0.5 unit increments, you might try using vial and disposable syringes in 0.5 unit increments.

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Permalink Reply by JohnG on March 12, 2012 at 9:26am

The novoPen Jr is a half unit pin. I have one and have used them for years to do
corrections on MDI.  Ask your Endo for one

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Permalink Reply by HPNpilot on March 12, 2012 at 12:29pm

Yes, that's the one I was referring to. One click is 0.5 units. Though you will waste 2 units priming it. I didn't care. The cartridges seem to be widely available

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Permalink Reply by Benjamin McLaughlin on March 12, 2012 at 12:33pm

I talked to Walgreens last week and they said their distributor no longer carried them. Even went online and chatted with one of their helpers there. They said they stopped manufacturing them in the US. I did some research but found nothing either way. I have been to two endos and both have said they didn't think you could get cartridges. Who knows.

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Permalink Reply by Type1Gal on March 12, 2012 at 12:36pm

i just got a refill of the cartridges from walgreens (for this novojunior pen) many children use these. you can always use a syringe with 1/2 units and just use a vial or the pens (if that's easier to transport) and draw up 1/2 units with a syringe from the pen too.

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