# Lowering calories severely and lowering insulin dose to match.



## stackingcups (Jan 3, 2022)

Hi all. Whilst I got the hang of upping my doses of insulin as needed, I haven't needed to reduce it before. 

After a Xmas of over indulging, I start my liver shrinking diet on Thursday for 2 weeks before my weight loss surgery. 

I have been advised to decrease my insulin by 20% the night before my surgery. I've been advised I will probably need to reduce it for the pre op diets too but not by how much. 

Do I reduce in anticipation, or wait and see what my levels are in response to the diet. It will be around 800calories a day which is a figure I think some of you are familiar with. 

I know I increase doses by 2 units a time, dose the same go for reducing? Any guidance appreciated.


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## Leadinglights (Jan 3, 2022)

I think you are going to need some specialist input into what will be the best ultimate course of action. It is going to depend on exactly what the 800 calories a day consists of which will surely determine your insulin requirement.
I think a lot of testing is going to be needed.


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## Lucyr (Jan 4, 2022)

It also depends on what kind of insulin you’re taking. Is it background insulin, fast acting insulin or mixed insulin?


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## Inka (Jan 4, 2022)

Looking back it seems you take Tresiba but no bolus insulin? I’d have thought it would be easier to be on a basal/bolus regime so you can make more suitable adjustments. Tresiba isn’t designed to cover food really.


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## stackingcups (Jan 4, 2022)

Sorry yes I'm just on Tresiba, they've declared that at the moment I don't have any need for a bolus. 

Perhaps it won't be as bad as I'm expecting? I think I just keep worrying about having a hypo. I've not had the ne yet and I'm not looking forward to it.


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## Inka (Jan 4, 2022)

stackingcups said:


> Sorry yes I'm just on Tresiba, they've declared that at the moment I don't have any need for a bolus.
> 
> Perhaps it won't be as bad as I'm expecting? I think I just keep worrying about having a hypo. I've not had the ne yet and I'm not looking forward to it.



I would question “they” then. The recommended regime for a 3c is usually the Type 1 regime of basal/bolus. It’s better to have less basal and tiny amounts of bolus, than just a bigger amount of basal. I think your situation is more complicated with your weight issue, but I’d still ask and research what others in a similar situation do regarding insulin regimes. Hi 

You’re quite right to be concerned about hypos. As Tresiba isn’t supposed to cover food/carbs, the only thing you could try is counting what you ate carb-wise on an average day and comparing it to what you’re about to have on the 800 calorie diet carb-wise. Look at the percentage reduction of carbs. I’d say it would be better to be a bit high than risk a hypo.

If you had a bolus insulin you could simply correct highs while you work it out. Perhaps you could ask for a temporary bolus insulin?


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## Lily123 (Jan 4, 2022)

Like @Inka said the Tresiba isn’t supposed to cover the carbs in the food you eat.The Tresiba is supposed to keep you stable when you aren’t eating so if you hypo going on a low calorie diet you could try reducing the calories slowly to see what effect it has on your numbers?


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## stackingcups (Jan 4, 2022)

I have been reducing slowly since Xmas and my numbers have stayed the same really so perhaps this isn't going to be as bad as I was expecting. 

The DSN and the hospital pharmacist are both expecting my insulin needs to go down post op, but someone here said surgery can bump up your needs so kind of interested to see how this all goes really.


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## Inka (Jan 4, 2022)

Will they be using a sliding scale during/after surgery? (An insulin drip)


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## stackingcups (Jan 4, 2022)

It was mentioned as a possibility.


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## stackingcups (Jan 4, 2022)

In fact I remember now the aneathnetist said I would be on an insulin drip during surgery.


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## Inka (Jan 4, 2022)

stackingcups said:


> In fact I remember now the aneathnetist said I would be on an insulin drip during surgery.



That might give them an idea of a suitable dose if you also keep it on after surgery. The drip will help them control your blood sugar well which will aid healing.

Good luck with the surgery and I hope everything works out well for you


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