I fast for a week once per season. To prevent lows I only use Humalog as needed (usually 2-4 units) and no Lantus. I was wondering if any of you have periods of time (for whatever reason) that you only use short-acting insulin and forego the basal form?
I was sharing my routine with someone and they stated that it’s the long-acting insulin that prevents DKA. Is that true? If so, I guess I’ve been lucky, huh?
There are so many variables so I am just looking for experiences.
That may work if you’re still in the honeymoon period - where your body still makes some of its own insulin. One of the things I was taught in pump training - which applies to injections as well - is that the body needs insulin constantly. I’ve had diabetes so long (60+ years), my body doesn’t produce even a single drop; so on the very rare occasion where my infusion set has come out, my numbers go up rapidly because there’s nothing running in the background to even try to help bring them down.
If you were honeymooning and your method worked for you in the past, be very careful - the honeymoon may be over and unlike marriage you may not be able to tell.
Thank you for replying, @wadawabbit
January marked year 6 since diagnosis after going into DKA. I never want to go through that again, for sure. When fasting my glucose usually drops and stays between 60-75. This occurs around 48 hrs. The first day or two it may rise to around 120-140 and I give myself a couple of units to clear the glucose.
Joy @TiJoy, it is possible to live [very well] on either short-duration insulin formulations or on long-duration insulin or, on a combination of both. I have lived, and managed, diabetes well on all three of these options. The most difficult of the three is what you are doing short duration [being described as insulin duration of up to 8 hours] without the assistance of a tool that will microdose. For more than 2 decades, I’ve only used Rapid-Acting [duration up to 5 hours] and Ultra-Rapid [duration <4 hours] the only two formulations that have been permitted in infusion pumps manufactured this century - Fast=Acting ha not been used since last century.
Looking back, the first insulins that worked in humans had durations oof up to about 6 hours, and were an ugly brown in color - looked like a diluted cola. I was fortunate to be diagnosed as needing insulin shortly after the new miracle NPH insulin came into play - we could live on ONLY one dose per day; a few varities of this type insulin with durations up to 36 hours with “timed” peaks and valleys of effectiveness.
Thank you for that history and explanation. I only use the short duration when I’m fasting (7-10 days tops). The rest of the time I use both short duration and a basal dose at night.
You are very welcome Joy @TiJoy.
Managing with the short duration takes a lot of time and you need to be alert to your body and understand clearly how insulin affects you at all times of the day. From what I hear you saying, I believe you have a really good understanding of your diabetes management. Using just a basal insulin [level effect all day long] would NOT work for ME; just getting out of bed when I was taking Lantus before bedtime, and not eating breakfast or taking morning bolus, my BG would rise by 200 mg/dl within 3 hours.
DKA and high BG, hyperglycemia, are not always associated; ketoacidosis or acetone poisoning is a bi-product when the body consumes stored fats because without insulin consumed foods can not be utilized. (I have personal experience with this that I have written about before; I spent days with BG over 500 - caused by infection - and no DKA; taught hospital staff and a few doctors how to effectively manage diabetes.)
That sounds super risky but maybe you are managing the risks. Does your plan include ketone monitoring? Does the time between Humalog doses ever exceed 4h? 6h? How much Humalog do you end up taking per day during a fast? Have you tried finding a Lantus does that works during the fast? Is the fast medically necessary?
I’m able to keep myself in range with between 2-6 units as needed. Each fast and each day of a fast can vary slightly. After day 2 or 3 I often only need the minimum units as I’m not consuming food and the liver is done kicking out sugar. I don’t lift heavy weights or anything too strenuous while fasting, so no sugar dumping there either.
I was just curious as to other’s experiences. Do you have one?
That is really interesting that there was no DKA with a sustained BG over 500. Once my BG was around 450 for some odd reason and I panicked before I realized that I felt okay and was able to bring it down easily. Our bodies are really something, aren’t they?
I don’t do multiday fasting. I was interested in your original post because I’ve had experiences trying to make do with only a rapid acting insulin and it was awful. Also some conversations with fellow T1Ds who use pumps and therefore no long acting insulin.
There is a spectrum of DKA, it can happen without symptoms Please talk to a MD about what you are doing. if you can’t find one open minded enough to listen try a video call appointment with https://integrateddiabetes.com/
Gotcha! So far no ill effects. If I experience any, I will most definitely adjust. Thank you for the link 
Everybody and every body is different. I’ve seen posts from people on the forum who like to stay under 100, but I personally start feeling funny if I’m below that number; and additionally I need to leave wiggle room for climbing stairs, which makes my numbers drop and which I can’t always plan for.
It sounds like your method works for you and that’s what matters. Just remember your body’s needs and responses may change from time to time - the honeymoon period could go for a number of years and its end would probably cause the biggest change, and sometimes they happen “just because” so don’t be surprised.
I highly recommend you check out the book Think Like a Pancreas by Gary Scheiner if you haven’t already. He has Type1 diabetes and works in the field so has a unique personal perspective that is particularly helpful.