All About Basal

Before I was a T1 diabetic, I thought that having diabetes meant taking a shot of insulin before eating which is what a lot of people think. Unfortunately that is only partially true and it’s a whole lot more complicated. I do sometimes get asked why I need my insulin pump connected to me 24/7.

There are two types of insulin needs called basal insulin and a bolus of insulin. What most people are familiar with is a bolus of insulin given before eating. Sugar is what cells use for energy and insulin is what the body uses to take sugar into the cell. The liver releases small amounts of sugar 24/7 in order to get the cells the energy they need. So a diabetic needs basal insulin 24/7.

Before the technology of insulin pumps came along, an injection of basal insulin was taken once a day. It is a type of insulin designed to release slowly to match the liver’s slow release of sugar. The problem is that the liver doesn’t release sugar at a constant rate. The liver releases a surge of sugar in the early morning hours to provide extra energy to wake up and get going. High blood sugar (BG) in the morning is known as “the dawn phenomenon.” But not every person has that surge and rates of sugar release can be different in different people, the only thing that is certain is that it’s rarely constant! It can be hard to keep a steady BG on basal insulin since it releases at a constant rate. Basal insulins also have a higher rate of side effects than fast acting insulins, the most common being weight gain.

When insulin pumps came along, they completely changed the game of diabetes management. There is no longer a need for basal insulin, the pump uses fast acting insulin and slowly releases it 24/7 in small amounts every 7 minutes. Different release rates can be programmed for different times of day based on individual need. This more closely matches what a healthy pancreas does. Want some exercise? A temporary lower basal rate can be easily set to help keep from going too low. When sick, a higher basal rate can be set. For women, PMS often requires a higher basal rate (I often need 50% more basal insulin) which is easier to manage with an insulin pump.

While insulin pumps have made T1 diabetes management easier, it still isn’t simple. There are more than 100 factors identified that affect BG, many of them the basal need. Changes in the weather, fluctuations in hormones, being sick, stress, medications, exercising, the list goes on and on! And many times, the cause of BG fluctuations from normal isn’t known. So even the most disciplined and knowledgeable T1 diabetics will have highs and lows. We make educated guesses all day long and hope that BG stays stable. Some days it just doesn’t. An insulin pump is a tool that greatly helps management (and there are more ways it helps too but that’s another blog for another day) but it’s still not the same as having a working pancreas.

The longer I live, the more I’m amazed by our bodies and how God perfectly designed them to work. I don’t remember often enough to thank God for all of the ways that my body does function properly. We are dependent on Him for every breath we take and should be thankful. So if you are fortunate to have a fully working pancreas, take a moment and thank God ❤️

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