Finding the chase and cutting to it

Back in 2000, I met someone with an insulin pump.  I’d had difficulties controlling my blood sugar with long acting insulin since I was a teenager and I didn’t have the tools to be able to tune my background insulin levels by using long acting insulin.

Unfortunately, I was “too well controlled” to gain pump funding (the highs from the long acting insulin not lasting long enough and requiring an extra shot of insulin followed by the frequent hypos at 2am because the insulin I need to cover the early morning were way too high for my two o’clock in the morning body to cater to but you know, doing great!) I self funded.

Which gave me unrestricted access to the pump company and the calculations and tools they had to hand.

At the time this was all passed on with paper charts and by mouth.

I soon realised, I was not in Kansas any more.

Kansas!?

The game had changed.  The rapid acting insulin had a pretty reliable behaviour which meant it could be modelled.  Models allow calculation tools to be built and given my new appreciation of a basal rate, I made those tools for me.

Through Insulin Pumpers Org (International), I learnt that not everyone had my ratios and indeed, my ratios may change.  Some people measured their blood and interstitial glucose in different units.  I evolved the calculators to cater to those needs.

I was keen to ensure that privacy was maintained for the users.  There are no cookies, very little javascript and the user doesn’t need a fancy browser.  This tool kit is designed to be simple and just work.

I’ve even made sure the colours and sizes can be changed if the user has visual issues.

When I was learning, the Insulin requirements calculator and Carbohydrate calculator made my life much easier.

If I’m hypo, the Carbohydrate calculator helps me get back to normal.

My newest tool is the Insulin on board calculator.  I use this most days to ensure I avoid highs and hypos if I don’t get my boluses right and when I do get it right. not to lose faith and give anything extra.  Along with my Freestyle Libre I can make meaningful decisions early.  I have perfected bolusing from experiences using this tool as well as you can begin to appreciate the patterns.

Eh?

Let me explain.  When a non-diabetic eats, their body can provide appropriate insulin levels in tiny doses to keep their blood sugar within a euglycemic range; that’s between 70 and 130 mg/dl according to the ADA or 3.9 and 7.2 mmol/l else where in the world.

As a type 1 diabetic, I’m not expected to be as tightly controlled because of the limitations of my treatment.  Again according to the ADA, euglycemic for a type 1 diabetic on multiple daily injections (or MDI), euglycemia is considered to be around 10mmol/l two hours after food.

With a pump, because our basals are closer to what they need to be, we can actually shorten that period down and on odd occassions, keep well below 10mmol/l without going hypo.  That’s the dream.  Today, having proven my basal rate yesterday, I am living the dream (today).

Normal basal all day.  No correction boluses.

Breakfast was 15g Rice Crispies (13g of CHO), 30 ml of milk (2g of CHO) and 250ml pink grapefruit (25g of CHO) – 4 units bolused as ratio is approx. 10g to 1iu.

Morning snack Soreen Lunchbox Loaf (8.6g of CHO).

Lunch was a bacon and egg sandwich (60g of CHO) and 250ml orange juice (25g of CHO).

Boluses: 4iu for breakfast (09:15), 2.5iu for lunch (12:20) with a further 6iu given over 15minutes.

Today, why is this qualified with Today?

Because tomorrow is the undiscovered country and the game is similar but not the same.