Timing is everything.

People that have Type 1 diabetes and that use an insulin pump to deliver their insulin have what’s called ‘basal rates’ in their pump. The basal rate for a particular time of day is our best educated guess as to what a working pancreas would be doing. Of course, I can not see inside my son’s body (or anyone’s body for that matter) so I don’t really know how to measure the amount of insulin that is being put into the body by a working pancreas. But rest assured, if you don’t have Type 1 diabetes, your pancreas is indeed doing the work for you.

A working pancreas knows how much insulin your body needs while it is sleeping, when it is waking up, or when it is going to play an active game such as soccer. While this is the same insulin a pancreas secretes into the body when someone eats, this is a little different because it is the background insulin that is going 24 hours a day to keep a person’s blood glucose nice and steady. Whether you eat or not your pancreas secretes insulin. It’s a busy little bugger that pancreas! And on top of all this, a working pancreas doesn’t care what time of day it is. If your teenager without diabetes sleeps until noon the pancreas knows that he is still sleeping so the pancreas still puts out the amount he needs while sleeping. Unfortunately this is not the case when using an insulin pump.

My son has 8 different basal settings programmed (by me) into his pump. The way we determined what setting he needs at what time of day is by testing his glucose throughout the day and evaluating the numbers. An on-the-money basal pattern should keep a person within 30 points. So, on a day when I want to check my son’s basal rate each blood glucose check should be within 30 points of each other. We don’t want to see too big of a drop or rise, we want to see an even line. That means that the pump’s basal settings are correct. The basal setting is for when the person is not eating, it doesn’t have to do with covering food with insulin, that is called bolus, but that’s another post.

Basal settings go by time. My son has one basal setting from 5:00am to 10:30am. Works great on school days when he gets up at 7:00am. Something must happen in his body upon waking that I have subconsciously figured out and he can stay pretty even. On the weekends when he sleeps later, past 7:00am, I have to watch his numbers. For my son, sleeping late means that his sugar will probably go low. So somewhere in his tiny body things are happening when he is sleeping that are different from when he is awake so the basal settings that work all the time with a 7am wake-up just don’t work for an 8:30am wake-up. I do not understand it for the life of me, I just know how it works.

The same does hold true for some food boluses. My son gets way more insulin at breakfast than he does with other meals. So if breakfast is at 7:30am and all is working smoothly, that is no guarantee that the same breakfast at 10:00am would work as well. Different time of day, different body rhythm that I am not privy too.

Being an external pancreas for someone is a difficult job, there are a lot of unanswered questions that leave you making very important life or death decisions based on a combination of research and intuition.

I’ve heard of mother’s intuition, but this is asking alot.