Basal and Bolus, the bane of my life?

From Diabetes UK

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!

The Carrot and the Stick

Some people have recently said on the forum how being told the bare, unpalatable truth about the consequences of poor blood sugar control has really made them sit up and start getting serious about their diabetes. If you let your guard slip then terrible things can creep up on you before you know it. So, sometimes tough love can be what is needed should complacency or rebellion set in. On the other hand, a person might find that encouragement is the key to success, possibly by being given the opportunity to get funding for an insulin pump with all the wonderful flexibility and enhanced control that brings. I feel that, currently, I am driven to keep good control mainly due to the fear of complications. This is not to say that I am in constant dread, but that I have an incentive to do everything by the book to give myself the best chance.

Diabetes nurses, so pleased you could attend,
Your patients will be glad you came – on you they all depend!
Today we’ll learn a technique called the carrot and the stick,
If carrots do not work for you, then the stick might do the trick!

Now, if a patient comes to you and their levels have been poor,
You might suggest a pump for them, describing its allure,
But sometimes a really harsh approach is the one that you should pick –
Frighten them with neuropathy and beat them with that stick!

They must avoid complacency, so keep them on their toes!
A pump might be a carrot dangled right before their nose,
And if you get their hopes up that a pump may soon be theirs,
You’ll be their favourite DSN – a nurse that really cares!

Assess your patient carefully, decide which method’s best,
But make sure that they know that they must inject, record and test,
For minor inconvenience they’ve everything to gain,
Avoiding complications and a life that’s filled with pain.

My Diabetic Auntie

I think for children with diabetes it’s very important that they learn from the beginning that it isn’t something that should hold them back in life and stop them from doing all the things their non-diabetic friends enjoy. There are many examples of great international sportsmen and women, and people in other walks of life that have reached the top despite the condition. But just as important, I think, are the ‘ordinary’ people – who may not have fame and fortune, except within their own social circles – but who demonstrate on a daily basis that they have fun, active and fulfilling lives. It may be that many people with diabetes actually have better lives than their non-diabetic friends. Being more conscious of a need to live and eat healthily means it is less likely they will drift into unhealthy habits that may come back to haunt them in later years.

So, this poem is a tribute to Lou, who is a wonderful person with a terrific sense of humour, and who I think has a positive attitude to making the best of things that kids would love.



Today we’re off to visit Diabetic Auntie Lou,
She’s such a lovely person, and I think you’ll think so too!
She says that diabetes shouldn’t stop you having fun,
When we’re with her we dance and sing and jump and swim and run!

She wears a pump called Veo, and I want one as well,
‘Coz when she has her insulin, then you can hardly tell!
It works out just how much she needs for every meal she eats,
And that includes for chocolate pud, and loads of other treats!

She has a special wizard friend that hides inside her pump –
He must be very tiny ‘coz you cannot see a lump!
She has some things called basals set that change throughout the day,
And even though there’s tubes and stuff, they don’t get in her way!

It made us laugh when Auntie Lou once made a pooping noise,
The pump alarm began to sound – she almost lost her poise!
She said it was the bubbles in the insulin reservoir…
That didn’t explain the eggy pong that filled up Auntie’s car!

But we all love our Auntie because I think you’ll find
You’ll never find an Auntie that’s so caring and so kind!
I hope that you have Aunties too, or maybe it’s your Mum,
That love you and that care for you – a super Sugarbum!

Snake Oil

A bit of a rant today! As with many chronic conditions there are some astounding claims made for ‘cures’ for diabetes. There is no cure for diabetes. It may be possible to gain better control of blood sugar levels by following certain strict diets or by taking certain supplements, but this does not constitute a cure, yet you will see adverts for cures all over the internet (you may even see some on this page, as part of the ‘targeted’ adverts from Google). As I am an insulin-dependent diabetic there is no substitute for insulin – I must therefore inject it to live. Insulin can’t be taken in pill form as the digestive juices in the stomach will destroy it before it can be passed into the bloodstream. Scientists are trying to find a way around this by coating pills in a special protective film so that it can pass into the small intestine unmolested, but this is still some way from being a reality. It is also possible to inhale insulin from a special device, but this method is expensive, difficult to guage dosages, and with unknown potential side effects on the lungs.

One promising area of research is stem cell research, where stem cells transplanted into the pancreas can be transformed into insulin producing beta cells. So far, this has met with some limited success, particularly in newly-diagnosed subjects who may still have some ‘native’ insulin production. There have also been pancreas transplants but this is not a common operation. Because the pancreas is also responsible for producing powerful digestive enzymes, the surgeons have a particularly delicate task trying to ensure that none of these powerful acids leak and damage other organs. Also, with transplants, the subject would then be on a plethora of anti-rejection drugs for life.

Another promising area is in ‘closed-loop’ systems that work like an artificial pancreas. These comprise a continuous blood glucose monitoring system (CGMS) and an insulin delivery device (a pump). The idea is that the CGMS takes frequent readings of blood sugar levels and commands the pump to deliver tiny amounts of insulin to ‘correct’ any high values – thus mimicking the way a real pancreas works. These devices are very close to being a reality. Things have certainly come a long way over the past 100 years, but have some way to go yet before we can all be ‘cured’!


‘Buy our pills!’ I hear you say,
‘Make diabetes go away!
Just take these three times a day,
Believe us – it’s the only way!’

Oh my dear, my goodness gracious!
What you claim is quite audacious!
The cure you offer is fallacious,
And your words are all mendacious!

Making money from the sick
Is such a nasty, evil trick,
So take your pills, one at a time,
And shove them where the Sun don’t shine!

The Blood Sugar Spike Correction Facility

Controlling diabetes can be an arcane art at times as there are so many variables to consider. In a non-diabetic person, the body is able to sense exactly when the blood sugar levels are getting too high and will instantly produce more insulin to ‘mop up’ the excess glucose in the blood. This can be extremely subtle, and it will switch off production the instant that levels are back in ‘normal’ range, so the levels don’t drop too low. A person with diabetes, however, does not have this fine level of control. Type 2 diabetics may still produce their own insulin, and not have to inject, but due to ‘insulin resistance’, it may be that the process is insufficient to ‘track’ and overcome the peak of glucose entering the bloodstream through food digestion. Those who inject insulin can have similar problems. They have to try and inject so that the peak action of the insulin being absorbed from the injection site coincides with the food digestion peak. If the timing is wrong, then the person’s levels can drop too low (if insulin ‘hits’ before food), or too high (if food ‘hits’ either before the insulin peak, or after – the latter being often the case with some foods).

Some people will counter this effect by testing their levels at 2 hours after eating, and adding a ‘correction’ dose of insulin if levels are too high. Sounds straightforward enough, except that there may still be active insulin from the original dose taken with the meal, resulting in an excess of insulin overall for the food consumed. This then has to be rectified by adding in a snack so the person doesn’t fall too low! Insulin pumps are particularly useful in these scenarios, as it is possible to either ‘dual wave’ or add in a correction dose without an extra injection. The dual wave splits the meal insulin dose so that there is sufficient active insulin circulating to deal with the late peak of glucose. Correction doses are also easier with a pump, as there are ‘wizards’ in the pumps that calculate how much insulin is already on board and adjust accordingly.


Welcome you inmates – and show some humility –
To the Blood Sugar Spike Correction Facility!
You’ve all been brought here, I think you know why,
For sending the blood sugar of people too high!

Pasta! Step forward! I don’t mean next week!
You seem to like dodging the Insulin Peak!
And you can stop sniggering Baked Potato and Beans,
You’ll be next to find out what the ‘Correction’ word means…!

Now, get in that stomach and don’t misbehave,
We’re going to subject you to a pump dual wave!
And Beans – on your own you seem to be fine,
It’s with Baked Potato you step out of line!

And all of you others – the Pizza and Cheese,
You won’t get away doing just as you please!
We’ll hose you with Insulin till you realise the futility
Of ending up here at the Correction Facility!