Basal & Bolus – What affects blood glucose?

Time flies! I just realised I am already eight months on insulin! I just can’t believe how these months are passing by so quickly.

A lot has changed since my last ‘insulin update’. The biggest change is undeniably the addition of long acting insulin into my treatment plan. I was pretty comfortable with my bolus (fast acting) insulin dosages before. Luckily the change from Jardiance (oral medication) to basal insulin hasn’t changed my initial ratios too much, so it seems.

For my non-diabetic readers:

- Basal insulin: the role of basal insulin, also known as background insulin, is to keep blood glucose levels at consistent levels during periods of fasting. When fasting, the body steadily releases glucose from the liver into the blood to supply our cells with energy. Basal insulin is therefore needed to keep blood glucose levels under control, and to allow the cells to take in glucose for energy. Basal insulin is usually taken once or twice a day depending on the insulin. Basal insulin need to act over a long period of time without a significant ‘peak of action’. That’s why it’s called ‘long acting insulin’.

- Bolus insulin: A bolus dose is insulin that is specifically taken at meal times to keep blood glucose levels under control following a meal. Bolus insulin needs to act quickly and so short acting insulin or rapid acting insulin will be used. It takes a while even for rapid acting insulin to work. That’s why (some) people may choose to inject a certain amount of time before starting to eat. It also depends on the glycemic index of the food you are having and how fast the meal will digest. The goal is to match insulin with the effect on your blood sugars.

The challenge is now to find my basal rate and how to adjust for things like very active days or my period. Yes, hormones have a big influence on your insulin sensitivity! I have been struggling a bit with out of the ordinary days (very active days, very sedentary days, sick days,…) But on ‘regular’ weeks I manage to get pretty stable nights and a good fasting glucose level most of the time -Remember, perfection doesn’t exist. So I think I have found the right basal dose, for now.

It made me think about all things that can influence our body’s insulin sensitivity/resistance and hence, your blood glucose levels. Diatribe has a very informative blog post about this topic, describing 42 factors that affect blood glucose.

So many factors! No wonder some days are off without me having a clue as to why or what has happened. It is so important to remind yourself that you are simply not in control of all these factors. In a healthy person, the pancreas will increase or decrease the amount of insulin secretion depending on what’s going on in the person’s body or what the body has to deal with. Unfortunately, that option is not available for us. Some people with MODY still make a small amount of their own insulin, which makes it ‘easier’ to regulate ones blood sugar levels. But some of us make so little to none it has no additional value. No matter what’s the case for you personally, we simply can’t expect ourselves to juggle this many balls all at once. Be kind for yourself if things don’t work out as planned. It’s good to be aware of these factors and to look for patterns. This makes it easier to predict or explain out of range values. But it doesn’t mean you have to beat yourselves up or feel guilty when things don’t go to plan. And you absolutely don’t have to try and control all of those!

I know I still have a long way to go in truly incorporating this way of thinking. Awareness is the first step, isn’t it? I just wanted to address this topic because I now many people with diabetes, no matter the type, are struggling with feelings of guilt and self-blame when their blood sugars go out of range. You are doing a fantastic job. Seeing this chart makes me able to give myself some grace and acknowledge that I am doing well enough.

Try to find some patterns. This will make it easier to manage your levels. But also be mindful of the fact you can’t control everything. Asses, adjust and go on with your day. Don’t let numbers get the better of you.

Take care.

Lots of love