The Power of Basal Insulin
I don't know if this is a common opinion, but I am truly impressed by the power of basal insulin. Even though, for me, the hourly rate of basal insulin is pretty low (between .40 and .70 units per hour) the adjustment of this rate can have a dramatic impact on my blood sugar control.
Several weeks ago I started tweaking my basal rates, particularly increasing my late morning to mid-afternoon rate from .40 to .50 units per hour. I had been battling some reoccurring highs after meals and figured more basal insulin would help smooth out the peaks. It worked like a charm!
Now, I know that a basal rate is supposed to provide just enough insulin to cover the glucose that my body consistently secretes. If I were to run true basal tests with the increased rate during the day, I think I'd learn that the rate is a tad too high. However, I can't argue with the results and lower post-prandial numbers are an important part of maintaining tight control.
After a few weeks with the increased rate, I changed the timing a bit. Instead of decreasing my basal rate at 4:00 p.m. (I tend to get low in the early evening), now my daytime rates are: .55 unit/hour at 8:00 a.m.; .50 unit/hour at 10:00 a.m.; and .40 unit/hour at 2:00 p.m.
The trick is, I believe, not to get into a situation where I'm "feeding the insulin" or always snacking to avoid going low. Basal rates are great because they're so adjustable versus using a long acting insulin to cover basal insulin needs. If I find that I'm trending low during the day, I can suspend or decrease my basal rate for awhile, which helps stabilize my blood sugar.
I suppose what impresses me about basal insulin is just how big an impact just a small change from .40 to .50 units can make over a period of a few hours.
You have to respect the power of basal insulin and pay attention when you make changes to your rates. This week we had a party at my office and I ate two small pieces of pizza. Since the fat in pizza infamously spikes blood sugar several hours after it's eaten, I increased my basal rate to .75 unit/hour for several hours after lunch. My blood sugars remained steady between 118 mg/dl and 89 mg/dl, until five hours after lunch when my blood sugar crashed to 59 mg/dl.
Unfortunately, the lows didn't end there. After coming up to 149 mg/dl before dinner, I bolused and waited a bit before eating. Immediately after finishing dinner, I felt low and saw 52 mg/dl on my meter. Apparently the increased basal insulin from my pizza indulgence stuck around awhile.
What's the moral here? An insulin pump provides much greater control over your basal insulin delivery. Use the power for good and avoid those evil lows!!