Thursday, November 17, 2011

Pumps and Setting Basal Rates. um, yeah..

A type 1 diabetic that follows a routine of Multiple Daily Injections (MDI) needs 2 insulins: 
- A short term insulin that you take every time you eat to process the carbs from the food
- and a long term insulin to process the hormones that your liver produces which manifest as sugars in the bloodstream
Those of us that wear insulin pumps, only have 1 insulin -the short term insulin on a constant drip.  This allows quite a bit of flexibility, because this steady drip of insulin, called BASAL insulin, can be adjusted to suit the users needs

The adjusting can be tricky.
Priority one, is to equip yourself with the Insulin Pumper's Bible, called Pumping Insulin by John Walsh.  This book adresses most situations and teaches you how to set and correct rates.

Personally, I have found that some levels are easier to set than others: for instance setting a level that will deal with Dawn Phenomenon.  
Dawn Phenomenon is an increased blood sugar towards the morning.  Basically, it's your body's way of saying it's time to wake up and eat.  The way I programmed my basal insulin in my pump to deal with it, was the following:

I wake up at 6AM
My insulin has a reaction time of 3 hours
I adjusted the rate from 3Am-6Am tweaking slightly every 2 days until I was waking up within range (which for me is 4.3-6.4mmol/L)

Setting daytime basals is much trickier though.... The goal is to have steady levels that answer your body's needs without any other factors contributing -like the doses for food (bolus).  SO you have to fast, and can then start to assess about 5 hours after your last dose for food (bolus).

So you choose a portion of the day that you want to assess. This means, find a day when you can fast.  BUT!  I don't want to fast!I love my meals and snacks!!!!
That means skipping a workout at the gym, possibly for a few days! 
I don't want to miss my Zumba class!  It's a highlight of my week!

OK, that aside, it's really hard to find an 'average' day, when you are contending with 
hormones -which for most women differs from week to week
And the activity level is almost never average -what of the 3 trips to the car to load up before dropping off your child at daycare, not to mention carrying around my 30 pound child, up the stairs, down the stairs...
AND, if you get all that right and you go low, then you learned that your setting 3 hours prior may be too high.  So you fix that, and the test is now over.  You have to redo it to lock in more numbers.

TRUTH: I kinda do my own version of basal testing/adjusting. I'm not suggesting it for anyone, but I'm being honest.
I did extensive basal testing once upon a time, I have those values set.
When I want to fix an emerging pattern, I test often and I  track everything
I eat the same thing several days in a row.
I spot check any numbers that don't make sense.

I can't be the only one though, can I?

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