Any other Type 1 Diabetic's in here? I know there are at least a few of us. I was informed by Express Scripts that they are discontinuing my basal insulin Levemir. Do you guys use something different? Do you like it? Any side effects?

I was on Lantus and switched to Levemir. Insurance is telling me I can do Semglee, Basaglar or Tresiba.

No personal experience, but I sell a mealtime insulin patch. The majority of the MDI patients I work with are on Tresiba for their basal.

Insulin pump, so I use Humalog or Novolog (which ever is currently favored by the insco) for everything.

For what it's worth, I asked a couple if the Endocrinologists I work with about basil insulin and they all said that Tiresiba has the best time release and is the most consistent 24 hour basal insulin

EMY92 said:

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Insulin pump, so I use Humalog or Novolog (which ever is currently favored by the insco) for everything.

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Same, I use a tslim pump and only take humalog.

Thanks, guys. Appreciate the assistance. I really like Levemir, but not much can be done about it now. I'll try the Tresiba. If it doesn't meet my expectations, I can always switch to something else. For those of us not in pumps, the basal insulin plays a critical role in maintaining good ranges. Without it, I'd need to give 2-3x the bolus insulin for the same control.

Can we make this the official type 1 thread? How much total insulin bolus/basal do my fellow pump users use per day? I feel like I may be experiencing insulin resistance.

Total basal is about 35-37 units. Bolus is obviously dependent on what I eat. I've been eating pretty high carb lately (eating bad during work busy season) and my 7 day avg is 35. My ratio is 1/5.5 or 1/8, depending on the time of day.

Quinn said:

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Total basal is about 35-37 units. Bolus is obviously dependent on what I eat. I've been eating pretty high carb lately (eating bad during work busy season) and my 7 day avg is 35. My ratio is 1/5.5 or 1/8, depending on the time of day.

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Okay - I am using ~26 units basal, but and roughly 60 units bolus (probably some to make up for the lower basal & bad diet & insulin resistance).

I have started intermittent fasting - has anyone else tried this as a type 1? I want to add in a keto diet as well. The goal is to bring my insulin usage and A1C WAY down.

Aggies1322,

I'm a Type 1. I use a total of 13 units per day of basal insulin. I give 8 units in the AM and 5 units in the PM. My A1Cs run from 4.5 - 4.7 and have been in this range for the last 18 years. I eat a high fat/protein very low carbohydrate diet and have been for the last 18 years. It wasn't until I started eating this way that my A1Cs got into the aforementioned range. Before, they'd run in the 7.2 - 7.5 range, which isn't good.

My total bolus insulin per day is 13 units. I use Humulin R at mealtime and use only Humalog to bring sugars into range if they get higher than I like. Higher than I like is anything above 110.

I am not, nor have I ever been, on a pump.

RightWingConspirator said:

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Aggies1322,

I'm a Type 1. I use a total of 13 units per day of basal insulin. I give 8 units in the AM and 5 units in the PM. My A1Cs run from 4.5 - 4.7 and have been in this range for the last 18 years. I eat a high fat/protein very low carbohydrate diet and have been for the last 18 years. It wasn't until I started eating this way that my A1Cs got into the aforementioned range. Before, they'd run in the 7.2 - 7.5 range, which isn't good.

My total bolus insulin per day is 13 units. I use Humulin R at mealtime and use only Humalog to bring sugars into range if they get higher than I like. Higher than I like is anything above 110.

I am not, nor have I ever been, on a pump.

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That's incredible.. I feel like I haven't been given any real education on diabetic management. I just started independent research after my FIL started talking about these things when he started doing independent research after being diagnosed with Type 2. I sort of expected my endocrinologist to speak up when they thought my insulin use was concerning (but they still haven't said much). That is with multiple endos. Very odd. Excited to see what keto/fasting can do for my BG. Thanks for that explanation.

My experience with endos are that they'll be the death of you. They'll prescribe medicines, etc. but they never actually help you manage your diabetes. When I took control of my own disease and used endos solely for prescribing meds, my control started to improve.

Shy away from any doctor that will not keep the same standards for you as he would for a non-diabetic. Do you want to live a shorter life than a non-diabetic? Of course not, so get your test performance results to the level of a non-diabetic.

Dr. Bernstein's book, "Diabetes Solution", changed my life. I suggest you buy it and read it immediately. I'm certain it will do for you what it did for me.

RightWingConspirator said:

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My experience with endos are that they'll be the death of you. They'll prescribe medicines, etc. but they never actually help you manage your diabetes. When I took control of my own disease and used endos solely for prescribing meds, my control started to improve.

Shy away from any doctor that will not keep the same standards for you as he would for a non-diabetic. Do you want to live a shorter life than a non-diabetic? Of course not, so get your test performance results to the level of a non-diabetic.

Dr. Bernstein's book, "Diabetes Solution", changed my life. I suggest you buy it and read it immediately. I'm certain it will do for you what it did for me.

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Thank you!

My take on Endos is that all the ones I have had (besides one who was ancient and needed to retire) were trying hard, but that they haven't been type 1 so they don't know what the day to day, hour to hour, minute to minute decision making process is like. Diabetes is a relentless disease and you have to make a good/right decision every minute of every day, basically.

Also, I tend to think that they feel some relief when they see patients who take care of themselves and have good A1Cs and control. They're so used to having to deal with trying to get patients to take care of themselves, that they relax some when they're with a patient who knows what they're doing. At least that's my interpretation.

As for treatment, RWC is clearly the gold standard. If you can achieve his level of control, that is amazing and the best thing for your body. For me, I don't have that self-discipline, but I am fairly happy with where I have landed.

I do eat cabs, but in an ideal world I would be having 20-80 a day rather than 100-200. Between a decent diet, exercise, and active control, I have a 5.8-6.0 A1C for the last 4 years.

The biggest piece of the puzzle for me was getting on a CGM. Having continual, real time day led to much better control of my blood sugars. I was even *****ing my finger close to 10x/day before I got a CGM, but a CGM makes such a huge difference in my opinion.

Good to hear all these stories. I am 4.5 days into my fasting & sorta keto diet. My BG is averaging 121 and avg total insulin intake is 51 units/day. Where my 30 day bg avg is 151 and 86 units/day. So there is a fairly marked improvement so far, and I am still working on becoming more keto/low carb.

Thanks for the input from everyone!

Keto/low carb working makes sense because you are removing or reducing the biggest variable that affects your blood sugar.

My two biggest pieces of advice are get a CGM and try and stick to a reliable eating schedule.

Yeah - I am using a Dexcom G6 with Tandem pump. The fasting is more a form of carb intake control. If I tell myself to only eat one meal, I will only eat dinner. And if dinner is my one meal, I have a better control over what I am eating because it won't be rushed like lunch usually is.

Be aware that if you go full keto/low carb you have to careful on the dosage of insulin. I used to use humalog when I first started eating this way but it was way too fast for someone eating foods that take a longer time to convert to glucose. I'd get inevitable lows right after a meal. It wasn't till I switched to Humilin R that I was able to bring it under control. Humilin R starts to work at a time when protein starts to convert. It's not perfect but it's the best available for my needs. Give it time. It may take a while to adjust, but in time you'll achieve blood sugar control unlike anything you thought possible.

I agree with Quinn completely. Endos are so accustomed to dealing with people who are falling apart that they really don't know how to treat a well controlled diabetic. I just tell them to prescribe the drugs I need and I'll see them once per year for routine blood work. Works for me. Best of luck to you and let us know if you have any questions. I'm always available to help out a fellow T-1 or 2.

Did you ever figure out a new solution, RWC?