The Basal Finagle.
There was a time when my “basal rates” consisted of a split-dose injection of Lantus: 12 units in the morning, 15 in the evening. That was it. 27 units of Lantus. I’d use my Humalog to bolus for meals and take correction doses, but there were no changes to my background insulin.
My how times have changed. I now use the OmniPod, and have the ability to have my basal rates change throughout the day, which they do no less than five times in a 24 hour period. I get less insulin in the afternoon when I tend to trend lower, more in the mid-morning when I tend to spike. Having a pump is like customizing your outfit for ever-changing weather: more coverage when you want it, lighter layers when the temp heats up. I love that flexibility because in folks who do have one of those fancy working pancreas thingys, their “basal” rates are constantly changing throughout the day. Having a pump means you can more closely mimic natural insulin physiology. And that, my friends is a powerful tool.
It’s also real frickin’ complicated sometimes. It’s great to have choices, but if your basal rates aren’t the right ones for the right times, they’re not doing you any good. And because having diabetes means wild variability in blood sugars and the way your body reacts to everything, it can be super tricky to ensure you’ve got the right amount of insulin at the right times. We all know with this disease that you can do everything exactly the same two days in a row and come up with different results. Which is why it’s important to minimize variables when you’re testing your basal rates. Which I’m really. Bad. At. Doing.
To test my overnight basals, I need to find a day where I don’t have any food and/or insulin after about 5pm, so that I don’t have any insulin on board or latent digestion through the night. This means being at home (away from restaurants/friends/temptation), and it means practically padlocking the fridge so I don’t nibble on anything when I inevitably get hungry at 10pm from not eating for five hours.
So, I sheepishly admit to you that I haven’t done this yet. But, I did make some changes. After looking at my blog posts from the last few weeks, and noticing that the can of frosting in my fridge is disappearing waaaay to quickly, I decided I’m having way too many lows - and many during the night - than is safe. I can’t wait for the perfect night to test my basals when I’m waking up five nights a week in a cold sweat from a low. So I made some small adjustments last Friday (only dialed down .10 units an hour for my overnight basals), and I’m checking to see how these play out. So far (it’s only been four nights, and two of those were on the weekend which involved all sorts of variables), it’s working out - I have yet to get low with these new patterns, and that feels pretty doggone good.
I’d be remiss in not giving proper credit here: it was my fiance who suggested I just dive in and change things on my pump. I sat across from him at lunch on Friday, exhausted from a bad low the night before. I lamented the frequency of this issue, and also that I was waiting for a good night to do a basal check.
“Why wait?” he said. “Just change it now. Why wait until you get low again?”
His point hit the nail on the head. Sometimes with diabetes, you just know something needs adjusting. There’s a zillion times it’s good to wait for your doctor or a proper test of something, but there are also times when you just know something isn’t right: it’s the high that you know is faulty cannula, not your dinner. It’s the moment you are certain that wasn’t a Diet Coke. Sometimes you just know. His comment was a good reminder to not wait until you have the right time - if it’s going to make you feel safer or help put a stop to something dangerous, then be that Captain of your Diabetes Ship and change the course.
Ha. Diabetes Ship. Doesn’t that sound like fun?
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Comments
It took forever for me to figure this out but doing it is a real life changer. I think you have to have some experience before you leap into doing this. But you and I are so well-seasoned that we know more about it than the endos do!
I never do basal testing. I make small adjustments when I see a trend developing. It does mean I’m always looking at trends but I hate doing all those testing things!
I love the easy to understand customizing-your-outfit example! That’s a great way to explain it to PWOD’s (aka: functioning pancreas people). I’ll have to remember that next time someone asks, “What IS that on your arm?”
And don’t you hate when a non-diabetic says something that gives you that “duh” moment? “Why didn’t I think of that??”
Great post, Alexis. I love your writing.