Treatment

A1c Tip: Increase Your Basal/Background Insulin By 1 Unit

Bolus insulin plus correction doses can whipsaw your blood sugars but small increases in your basal insulin can often smooth these cycles

Yes, just 1 unit.

I bet you’re thinking: “But I have low blood sugars all the time! Increasing my background insulin will just make me go low more often!”

Have you been trying to lower your A1c for months and months now? You’re eating a healthier diet — more whole foods, fewer crackers, less sugar — and you’re walking every day and checking your blood sugar often.

But your A1c just won’t budge? And on top of it, you’re constantly correcting highs and juggling lows.

Frequent low blood sugars can mean you need more background insulin

While there are certainly times when frequent low blood sugars can mean we’re getting too much background insulin, the opposite can be true as well.

Picture this: if you’re often higher than your goal range before or after eating, you’re likely taking frequent “correction doses” of insulin. Those correction doses are stacking up on top of insulin you’re taking for your meals, too.

If what you actually need is more background insulin, these frequent correction doses are going to lead to lows because they are inevitably delivered in too large of a cumulative dose.

Background insulin is supposed to be a drip, drip, drip from your pump, or the gradual action of long-acting insulin.

If you’re constantly correcting highs with boluses of insulin because you’re not getting enough background insulin, you’re going to experience constant lows, too.

The magical impact of just 1 more unit

To achieve an A1c in the 6s, you’d need your blood sugars to be “hanging out” in the low 100s throughout the day. If you aren’t getting enough background insulin, that’s going to be an uphill battle.

By increasing your total background insulin by 1 full unit, you’re going to bring your “hanging out” blood sugar down just a smidge. Making it that much easier to meet your goal range.

Obviously, you should talk to your diabetes healthcare team before making big changes in your insulin dose regimen, but let’s take a closer look at what this means:

If you’re on a pump…

If you’re on a pump, adding 1 full unit of insulin to your total background insulin means increasing your basal rate by .1 unit for 10 hours of the day. This is likely going to be 10 hours during which you are awake (6 a.m. to 4 p.m., for example). Or if you’re struggling to stay in your goal range during the night, too, maybe you’re increasing all of your basal rates by .1 unit!

If you’re on long-acting insulin…

If you take one injection of long-acting insulin every day, you’ll simply increase your dose by 1 unit.

If you take two injections of long-acting insulin every day, you could increase both doses by .5 units, or you could make an increase of 1 full unit in whichever dose covers the half of the day that your blood sugars tend to run higher during.

When life changes, your insulin needs change, too.

Personally, I’ve had to make 1 to 2 and even 3 unit dose changes to my long-acting insulin over the past year even though my weight, diet, and activity level haven’t changed. 

This is because of stress! Stressful events (like divorce) are just one of the many examples of real-life variables that can call for an increase in your insulin.

That underlying level of daily stress while I adapted to the many changes that come from separation and divorce was enough to call for a regular increase in my background insulin dose. And then, about 6 months later, I could decrease that 13-unit dose down to 12 units, and then 11 units.

Weight-gain, changes in diet, less activity, an injury, increased stress — you name it — all of these things can call for an increase in your background insulin. And sometimes, just 1 unit can make all the difference. 

Ginger Vieira has lived with Type 1 diabetes and Celiac disease since 1999, and fibromyalgia since 2014. She is the author of 4 books: Pregnancy with Type 1 Diabetes, Dealing with Diabetes Burnout, Emotional Eating with Diabetes, Your Diabetes Science Experiment. Ginger creates content regularly for Diabetes Strong, Healthline, HealthCentral, DiabetesDaily, EverydayHealth and her YouTube Channel. Her background includes a B.S. in Professional Writing, certifications in cognitive coaching, Ashtanga yoga, and personal training with several records in drug-free powerlifting. She lives in Vermont with two kiddos and two dogs.

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