Think Like a Pancreas: Chapter 6, Your Cheat Guide!
Your basal insulin serves as the foundation for your entire insulin program. If you have a high or low blood sugar, knowing what to adjust is difficult unless you already have established the proper baseline.
“With a solid, level foundation, you can build something great, but with a cracked or crooked foundation, you will need to manipulate everything placed on top of it in order to avoid epic disaster.” —> In laymen terms: If your basal insulin dose is not set properly, you will be constantly adjusting your rapid acting insulin and/or food intake to avoid highs and lows.
When looking at typical dosing patterns and formulas, use them only as starting points—everyone’s needs vary.
Initial Basal Dose for Those Injecting Insulin
First, one must mindful of what factors affect your insulin requirements:
Age (stage of growth, i.e. hormones).
The amount of internal production of insulin from your own pancreas (if any).
To estimate your total daily insulin requirements review this table:
K… kind of confusing, now what?
First, convert your weight to kilograms (your weight x .454 = kg) then multiply by the total daily insulin requirements (units per kilo body weight) found on table 6-1
1. (Weight) 140 x .454 = 64.56 kg
2. (Moderately Active Adult) 64.56kg x .50 = estimated 32
3. (Moderately Active Adult) 64.56kg x 1.0 = 64.56
Total estimated daily insulin requirements for a moderately active adult weighing 140 = estimated 32-65 total units daily (this will vary base on carbohydrate intake & insulin sensitivity).
To estimate your total basal insulin requirements review this table:
First, convert your weight into kilograms (your weight x .454 = kg) then multiply by the daily basal insulin requirements (units per kilo body weight) found on table 6-2.
Example: If your weight is 140, age is 25, and your’e very active:
1. 140 x .454 = 64
2. 64 x .15 = 9.6 units
3. 64 x .40 = 25 units
You would require between 9.6-25 basal units. Starting conservative is most ideal, slowly increasing and/or decreasing based on your trending highs or lows.
More tid-bits for your fine-tuning basal adventure:
—How many carbs do you eat in a day? Estimating your daily carb consumption is crucial. Lower carb eaters generally have larger proportion of basal insulin than higher carb eaters because they are using less fast acting insulin prior to meals…i.e. less stacking of larger amounts of insulin
—The right dose of basal insulin should keep the blood sugars fairly stable during the night (given you do not eat, take rapid acting insulin, or exercise.)
—A consistent rise or drop of more than 30mg/dl indicates a need to change the basil insulin dosage.
How do you determine if your basal needs adjusting?
- Eat a healthy dinner: Low carb and low fat—think veggies and lean protein! Fat can trigger a rise, and carbs increase variability in blood sugar numbers.
- If pm exercise is part of your norm, go ahead, but nothing too long or too intense. This can cause blood sugar drops several hours later.
- Three hours after dinner, check your blood sugars. As long as your blood sugar is above 80 mg/dl and below 200 mg, do not take any food or insulin and proceed with the experiment!
- Check your blood sugar again in the middle of the night and first thing in the morning.
- If your blood sugar rises or falls less than 30 mg from bed time to wake time, congrats! Your basal dose is likely in good range.
- If it is dropping by more than 30 mg, decrease your basal by 10% and repeat the test.
- Continue to adjust until your blood sugar holds decently steady through the night.
- Confused? Think this:
- If you were going to sleep at 185, and woke up at 120, your basal is too high since it dropped by 65 mg while you slept.
- If you were going to sleep at 87, and awoke at 160, an increase in the basal insulin would be in order.
- If you were going to sleep at 95, and woke up at 77, WOOHOO! Minimal change = correct dosing for your body (for now).
Killer Somogyi. What the heck?
The Somogyi Phenomenon (named after its discoverer) is when you drop during the night (below 70), and your body secretes hormones that raise the blood sugar by morning.
Long story short, you need to know what your “in the middle of the night” blood sugar number is to ensure your wake-up number is an actual depiction of your blood sugar levels.
While you may waking up high, you could be dropping low and rebounding to a higher level by morning.
Next week..... we will dive into (Part II) Fine Tuning Pump Basal Rates.
I didn’t want to overwhelm you with too much info this week.
My goal is to make this as simple as possible.
When numbers, a sucky pancreas, and "guesstimating" are involved…. I know things can get overwhelming.
You got this!