Ad hoc

Of course, it was not easy from day one. Predictable calculation of bolus insulin only applies when the basal rate of the pump is set correctly. Until that you are still in a situation where the basal insulin might influence in a way you do not want. Therefore, the big task in the beginning is to isolate things.

During our diabetes ‘career’ until now, we had been taught that slow acting carbohydrates were the best thing. Not only with regard to general health, but in order to adapt to the injected insulin. Now we had to reconsider that. We had to realize, that pasta and rice, for instance, are hard to handle in the beginning of ‘life on pump’. They influence the blood glucose for so many hours that it might be difficult to tell whether high blood glucose five hours after a meal is the result of too little insulin for the pasta or a basal rate that is set too low.

So we found that during the running in it would be easier to stick to fast acting carbohydrates as for instance potatoes and white bread. After an evening meal based on potatoes we knew, that after around three to four hours we could see the full effect of the carbohydrates and the insulin we had given. And then we could concentrate on the basal rate adjustment for the rest of the night.

“But – for the rest of the night? Was not one of the points to minimize the need for blood glucose testing at night?”

Well, it was. And we did, eventually. But the foundation for successful pump therapy is a basal rate, which is set correctly. Especially at night. So in the beginning you have to measure at night perhaps more often than before.

An important observation was, by the way, that even though our basal rate was not perfect from day one, it was much easier to handle than the basal long acting insulin we used during the pen years. Almost immediately the brutal dives in blood glucose values in the afternoon was gone. We saw the effect of not having the peak of insulin action after eight hours that we were used to. And in our opinion, the action profile of the insulin was far more predictable than before.

This is the ninth post in a series - read the first post here.

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