October 22, 2015

Insulin vs. the Clock

The clock is one of my dearest friends. At least, when it comes to controlling blood sugar.

I know this sounds silly. But it turns out that insulin does not always get absorbed at the same rate. And knowing when and how to make the correct adjustments has made an incredible difference for my health.

It’s all about timing:

I’ve been insulin-dependent for over 25 years. But only recently have I begun to realize that correct timing is one of the best ways to keep my blood sugar stable.

I use an insulin pump, a continuous glucose monitor, and a glucose meter for type 1 diabetes. The pump gives me insulin in two ways:

  • basal insulin: This is a constant drip. It’s set at various hourly rates throughout the day to reflect my activity levels.
  • bolus insulin: I take these kinds of doses for food or to correct a high blood sugar.

Sustained Activity Adjustments:

Thinking ahead is key for any type of sustained cardio activity, especially when it’s outside of the daily routine. Even a thirty-minute walk can affect my blood sugar. So one hour before I start exercising, I lower my basal rate. For example, if I plan to hike two hours, I take a decreased amount of basal insulin for two hours. The reason I do this an hour ahead of time is because the insulin tends to be on a one-hour delay. So lowering the basal from 1-3pm would set me to be receiving that lower basal from 2-4pm.

Cardio Workout Adjustments:

“Beep-bep-beep!” I have an alarm set in my pump that reminds me to adjust my basal setting for more routine workouts. It goes off one hour before my cardio fitness class usually starts. Since I don’t take the class every day though, I have two different responses to this alarm:

  • If it’s a day that I won’t be working out, I just silence the alarm.
  • If it’s a day that I will be working out, I set a one-hour temporary basal rate. I’ve found that lowering the rate to 75% of what I usually take is about right to keep my blood sugar stable throughout the class.

Extended Inactivity Adjustments:

Once in a while, I am subjected to day of sitting. For times like this, I increase my basal rate. For example, if I’m going to be in a car from 1-5pm, I raise the basal rate from 12-4pm. Setting the rate to 140% of what I usually take keeps my blood sugar from creeping up while I’m traveling.

 Heavy Weightlifting Adjustments:

I’ve heard that heavy weightlifting can increase your blood sugar. But this never seems to be the case for me. I usually lift weights for about 30-40 minutes, and leaving the basal rate as-is works just fine. Maybe I need to look into lifting even heavier weights J

Treating a High:

I don’t like high blood sugar. When treating a high, my initial reaction is to take a whole bunch of insulin as soon as possible. But I’m working to control this impulse, since it usually just makes everything worse. Instead, I take a correction bolus and wait. The correction bolus will work towards bringing my blood sugar down over the next three hours. So I generally avoid taking any more insulin during that time. And if I’m patient, I’m usually rewarded with the beginning of a gentle decline on my pump sensor graph within an hour.

Post-Fasting Adjustments:

If I haven’t taken a bolus for food in the last six hours, my body goes into a state of delayed insulin absorption. To accommodate this delay, I take my breakfast bolus and then wait. It can take 30-60 minutes for the insulin to affect my system. I keep an eye on the clock and my sensor graph. After 30 minutes, I check to make sure my blood sugar isn’t going up, and then I start eating before it begins to drop.

Happy Timing!

I hope you found this article to be helpful. Feel free to leave a comment or check out more of my articles on twitter @Robinrjsmith.