Monday, 14 June 2010

Basal and Bolus, the bane of my life?


I’m on an insulin regime known as ‘basal/bolus', also known as MDI (Multiple Daily Injections). Basal insulin is slow-acting, and one injection lasts around 24 hours, in theory at least. Bolus insulin is given to match the carbohydrates in a meal or snack, or to correct a higher-than-I-feel-comfortable-with level, usually double figures for me, although I have only made three such corrections in two years.

Sounds pretty straightforward, yes? Well, for me, I’m lucky that most of the time everything seems to be fine. Just lately though, chiefly due to my enforced withdrawal from the running fraternity due to my injured knee, things have been going a bit all over the place. My levels generally crept up, so I had to try and estimate how much additional insulin I needed for each 10 grams of carbohydrate (known as a ‘ratio’), and also if I needed to increase my basal insulin to keep me steady and in range when I wasn’t eating.

After a few weeks of doing this and getting mixed success, I’m now back exercising, which means I’m now having to reverse the trend and start decreasing my insulins – more mixed success! Currently, it appears that I’m taking too much insulin, as my levels have dropped low several times over the past few days. Basal insulin is harder to deal with, as its effects can take a couple of days to manifest so you need to try and see into the future! Life would be much easier on an insulin pump, since adjustments can be made in tiny amounts and at very short notice, but my chances of getting a pump are virtually zero due to my overall good control and the expense of a pump.

Still, it could be far worse! I have pretty good control compared to a lot of people, and whilst not perfect, the adjustments I make seem to be fairly close to the mark. It’s just hard having to think ahead and pull numbers out of the air day after day! Hopefully, once I am back in regular exercise, everything will settle back down again.

Basal and Bolus, the bane of my life!
One day they’ll work fine, the next they’ll cause strife!
For it’s not just a case of injecting four shots,
But having to think of the ‘do’s’ and ‘do nots’.

I do need more basal if I should awake
On a level too high for my night fast to break,
But if I should wake with my levels too low,
That’s a sign that some of my basal should go.

But how to predict it? And how to react?
There’s no way of knowing each pertinent fact!
For our bodies are so complex, and our methods so crude,
It’s hard to outguess both our liver and food.

Bolus, you’d think, would be easier to know,
For we just need to use the correct ratio…
But if we don’t weigh every grain, every gram,
Then in truth, it’s an estimate, maybe not worth a damn.

And basal? That’s bothersome in a different way.
You can only adjust every two or three days…
And between now and then, what will happen? Who knows?
I can only adjust and then see how it goes!

I may whinge, I may moan, how my life’s so unfair,
And envy those others who don’t have such cares.
But the bottom line’s this, it has to be said –
I’d rather have this than be lying there dead!

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