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Diabetes Maintenance

When things come up in life, I tend to write about them. In the end, that's what a blog is for, right?  Today is the first day of a 3-day stint of the fun that I get to deal with called a basal block study. (at least that's why my Endocrinologists office calls it)  What does this mean?  Well, this means not much to people without diabetes as your body takes care of the basal insulin properly.  If you haven't read my first Diabetes post, I suggest it as today's post builds off of it quite a bit, start your detour now, and then return.

Alright, you know the basics of how diabetes affects me and other diabetic patients, let's get into the concept of the basal block study.  When I look at my insulin intake every day, there are two contributing types of insulin, the basal insulin, given at a continual pace to compensate for normal cellular metabolic rate, which usually is indicative of your base metabolic rate and the bolus insulin, or insulin given to correct a high blood glucose or to counteract food being consumed.  When you have less-than-ideal glucose control, there are two items that need to be checked, your basal rate, and your bolus ratio.  The basal rate is the amount of insulin you receive per hour (units per hour) and is supposed to match your base metabolic rate.  The bolus ratio is the number of units per carbohydrate (either gram or carbohydrate exchange) that you are supposed to give yourself.  My current insulin pump settings for basal rate are:

  • from 12:00 AM until 6:00 AM - 5.00 Units/hour
  • from 6:00 AM until 10:00 AM - 4.60 Units/hour
  • from 10:00 AM until 7:00 PM - 4.65  Units/hour
  • from 7:00 PM until 10:00 PM - 4.25 Units/hour
  • from 10:00 PM until 12:00 AM - 5.00 Units/hour
This ends up with me receiving 113.0 Units per day for basal insulin. (roughly a 4.71 unit/hour average)

Once again, what is a basal block study?  A basal block study is a way to test the basal rate for a given time.  My doctor wants these studies done in 4 different time windows, 12:00 AM - 6:00 AM, 6:00 AM - 12:00 PM, 12:00 PM - 6:00 PM, and 6:00 PM - 12:00 AM.  Inevitably, this becomes the 3 meals of the day and overnight.  Tonight is my first basal block study, starts at 6:00 PM (anywhere from 1 to 2 hours ago depending on when I finally get this posted) and ends at 12:00 AM.  During this time, I cannot eat food starting about 3 hours prior to the beginning of the basal block (3:00 PM) until the end of the basal block (12:00 AM) so that I can check the validity of my basal insulin dose.  Once I start a basal block study, I must adhere to the following rules:
  • Glucose must be tested and recorded every 2 hours
  • If glucose drops below 70, I must correct the low insulin and stop the study
  • If glucose is above 250, I must take corrective actions (bolus) and stop the study
  • Otherwise, move forward with the study
With the data that I collect of this time period, I look at the difference in my glucose over the time and make a decision on what I should do to improve my glucose control.  Because of the continuous glucose monitor (new since the last time I did this study) I get a virtual test every 5 minutes which really helps me to dial in my basal rates much more consistently.  The other important thing to note is the time that it takes for the insulin to affect my glucose, this is important because I need to look at the major slope changes and go back that amount of time in order to look at where my basal rate should change.  When I get results back from my basal block study, I will share them and show my process as I think it's important that others understand what exactly I am doing.  It's been 1 hour and 15 minutes since I started my basal block study and I've already had to cancel tonight's night meal skip as my glucose dropped below 70 mg/dL.  I will attempt to continue it with my lunch-time block tomorrow.  This is a highly involved process, but it ends up being worthwhile in the end, as it can assist in the small fixes, and I now have WAY more tools at my disposal than I did the first time I did a basal block study.  

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