Tuesday, May 22, 2012

You're Only As Good As Your Basal

Articles - Diabetes Articles
Tuesday, 28 December 2010 08:22
The basis on which a thing stands, is founded, or is supported...


"FOUNDATION"


As a good solid home requires a stable foundation, diabetes requires the fundamentals to be in order. I believe you are only as good as your basal. If your basal is off, well your correction factors aren't "real". If your basals are off, your I:C ratios are smoke and mirrors. If your basals are off your foundation is not so sound.

I am ashamed to say I haven't done a daytime basal assessmenet on Joe's settings for about a year. Joe is a seven year old boy. He is growing.

His body is changing. His insulin needs are dynamic. And...yet...I haven't gone back to "the basics" to assess his needs. I have been a lazy pancreas and in essence a less than optimal parent. Remember, the basic, basic, basic definition of parenting is promoting "physical" development.

I decided to look at Joe's numbers over the past few weeks and really break them down. I don't upload his data. I log by hand and I figured out this data by hand.

Week 12/20/10 to 12/26/10
59% of BGs were within 70 to 200
33% of BGs were over 200
7.6% of BGs were under 70
Blood Glucose Range: 45 to 455
Sample size was 78 Blood Sugar checks in a 7 day period

* Considering it was a week filled with pre-Christmas and Christmas festivities and hockey and backyard skating I am not beating myself up too much over these results.

A couple of weeks prior...

Week 12/6/10 to 12/12/10
71% of BGs were within 70 to 200
21% of BGs were over 200
7.7% of BGs under 70
Blood Glucose Range: 44 to 330
Sample size was 90 Blood Sugar checks in a 7 day period

I like the results from this week better for obvious reasons. I am not sure about a "standardized" set of goals. I think Diabetes management is so "individualized" that it is unrealistic to set up a "standardized" system that everyone must attempt to adhere to or to set goals for everyone to attempt to obtain.

I am fairly OK with week 12/6/10's results. I would like the "low Blood Sugar" percentage to be less. Otherwise, I think 71% in range Blood Glucoses is a pretty rock solid number considering: Joe is seven; Joe plays hockey four times weekly; Joe skates and sleds daily in single digit temperatures (low inducing behaviors and conditions for sure).

I did finally have Joe sit still from 6am until 1:30pm yesterday. I had Joe eat no carbs. I checked Joe's blood sugar every hour to hour and a half. I did a basal assessment. A basal assessment is where you limit activity, no carbohydrates are consumed, and you check blood sugars every hour to every other hour to determine if your underlying insulin rates (basal rates) are adequate (Blood Glucose levels will remain essentially unchanged), too small (Blood Glucose levels will rise), or too large (Blood Glucose levels will fall). The basal assessment is over once the Blood Glucose is over 220, less than 70, or the child can no longer go without carbs. I had to bribe Joe with mac and cheese and ice cream to get this done.

Here is what Joe's Basal Assessment looked like:

6:30am BG 173 -> 8am BG 196 -> 9am BG 117, rechecked BG 113 -> 9:30am (Joe complains he is low) BG 122 -> 11am BG 161 -> 12pm BG 128 -> 1pm BG 98 -> 1:30pm (Joe complains he is low AND hungry) BG is 71 -> BASAL ASSESSMENT IS COMPLETE!

I have a couple of basal rates that need tweaking and then subsequently I think his lunch ratio will need to be stronger as I dial down his basal around that time. Only time and more studying and tweaking and logging and studying will tell.

I stumbled upon this yesterday. Have you heard of it? Type 1 University? I am excited to scope out some of their on-line courses. I want and need to do a better job by Joe.


How often do you do basal assessments? AND...how do you conduct them?

A day-in-the-life of the nuts and bolts of managing the "foundation" of pump therapy.

Post Edit: I forgot to mention that after a basal assessment...with Joe's first carbs of the day (even if they aren't until 2pm) I have to bolus him at his "breakfast ratio" (of a 1:13) instead of his lunch/afternoon ratio (of a 1:28). It seems that he needs a "huge ass whack of insulin" with his first intake of carbs no matter what time he consumes them. Has anyone else noticed this?
 
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