My thoughts on background insulin and the part it plays in maintaining the complex balancing act.

Much has been said about rapid insulin and the positive benefit it has had on diabetic control over the last decade. Background – or long-lasting insulin – also plays a part in maintaining a complex balancing act.

The human body produces a constant flow of its own glucose called glycogen. This glycogen production is normally counterbalanced by the pancreas; which produces just enough insulin to break down the glycogen – for normal people, anyway.

A type 1 diabetic has no natural means insulin production to counterbalance the glycogen production – so we need to inject insulin into our bloodstream. In addition to injecting rapid insulin, diabetics can inject long-lasting, slow release insulin. This background insulin lasts up to 24 hours (rapid insulin lasts up to 4 hours). Its main purpose is to assist in balancing the body’s natural glycogen production.

When I was diagnosed with type 1 diabetes I was put on a set dose of rapid insulin (Novorapid) and background insulin (Levmir). As previously documented in this blog I quickly worked out my carbohydrate to rapid insulin ratio, thus improving control of my glucose levels.

Despite this breakthrough I was finding that even when the rapid insulin was not present in my bloodstream – after a long sleep, for example – I needed to consume 20 grams of carbohydrate every few hours to prevent my levels dropping too low.  I eventually discovered it was because my background insulin dose was too high.

During a concert one evening I easily consumed over 60 grams of carbohydrate – the equivalent of a main meal – over the course of two hours without taking any rapid insulin; my blood levels did not raise above ‘normal’ levels during the whole time.

Standing up for long periods consumes energy, but not to the degree where I’m required to carry a bakery in by backpack! After a brief consultation with the Professor of Diabetes at my local hospital I was encouraged to experiment with by background insulin levels.

My initial dose of background insulin upon diagnosis was 16 units. Every week I would reduce this by 2 units to see how it affected my day-to-day routines. My method was to spread out my meal times so that the rapid insulin would be absent from my bloodstream at certain times of the day – preferably when I was resting.

I would then test my glucose levels every few hours to determine if my levels were still falling without the aid of the rapid insulin. The final test was to eat a zero carbohydrate breakfast – like chicken or scrambled eggs. If my glucose levels continued to fall during the course of my morning routine, then further adjustment was required. I kept this up for a few months.

At present my background insulin dose is 8 units – half the dose set by my diabetic specialist. I no longer need to snack every 2 hours – which has helped with my diet – and I sleep better knowing that I am less likely to get woken up by a hypo.

Over the years, through experimentation, I discovered that less background insulin is needed during hot summer months. In colder weather I increase my doses – though not as high as first prescribed.

The pay-off is that I now have to take a few units of rapid insulin when consuming some snacks that the background insulin would normally have coped with by itself. But it’s a small price to pay for more freedom and less food!

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