Playing with Temporary Basal Rates
Pregnancy Tracker: 25 weeks, 2 days
Size of the Baby: 9 whole inches!
Biggest Obstacle: Staying motivated.
As I recounted my list of "daily health resolutions" in my last post, I realized that item #3 might require a bit of explanation.
I included "practice temporary basals" in my list because of a particular issue I've been noticing of late. Whenever I eat anything with a decent percentage of fat, protein, or even fiber, I notice a blood glucose spike several hours later.
This tends to happen most often after dinner. Thus, I'm waking up to numbers over 150 mg/dl in the middle of the night, and not liking it one bit! One night, after a delicious lentil stew dinner (made by my mom!) my blood sugar was 110 mg/dl at 12:30 a.m. and then 232 mg/dl at 3 a.m. I realized that the high fiber content of that meal delayed the blood sugar response. If I'd set a temporary basal rate, say up from .50 units per hour to .85 units per hour, I could have controlled that spike.
The problem with these delayed highs is that they always make sense to me after the fact. I needed a way to proactively and preemptively keep those highs at bay. With a daily resolution to practice using temporary basal rates, I would be forced to look at my meals and determine what type of blood glucose response I could expect.
So far, I've had some good luck. I had that same lentil stew for lunch yesterday. I set a temp basal of .75 units per hour (up from .50 units per hour) for 5 hours after eating. My blood sugars were great: 99 mg/dl at 2 p.m.; 73 mg/dl at 4 p.m.; 103 mg/dl at 6 p.m. I've similarly had positive results when setting temp basals after dinners such as a Spinach Beef Burrito.
You can obviously achieve the same type of insulin dosage over a long period of time by using a Combo bolus or a Square-wave bolus. I, however, seem to have a mental block when it comes to using that tool. On my Cozmo pump, you enter the amount of carbs you're having and then deliver the total amount of insulin for that number of carbs over several hours. If I'm eating something with a good portion of fat and/or protein that has only 45 grams of carbohydrate in it, and I bolus for just the carbs over 2-3 hours, I'll be high.
The need for additional insulin, in these cases, comes from the protein, fat, or fiber, not the carbs themselves. Thus, bolusing just for the carbohydrate content isn't enough. Mentally, it makes more sense to me to up my basal rate, because then I don't confuse that additional insulin with the actual meal bolus.
Setting a temporary basal rate also comes in handy during exercise. About 2 hours before a long walk or swim, I cut my basal rate in half. This leaves me with less insulin-on-board for my workout, thus my blood sugars do not drop as dramatically. This works particularly well for swimming since that kind of workout tends to drop my blood sugars quite a bit.
All in all, I'm enjoying my experiment with temporary basal rates. They are a great example of how an insulin pump can allow us to fine tune our insulin delivery to our body's particular need.
It feels good to add another tool to the arsenal!