Diabetes Self-Management Blog

Finally! After a month (or so), I think I have my basal rates pretty much in order. The necessity to change my rates became apparent after I had surgery on May 10 to remove infected bone from my calcaneus (heel bone).

With removal of the infected part, my insulin requirements dropped. As if that weren’t enough, antibiotics caused my insulin dose to drop even further, albeit not as quickly as it did immediately after surgery.

Right now, I’m taking about 60 fewer units of insulin a day than I did before surgery. Adjustments likely aren’t over yet, either: My lab tests are showing that I still have an infection…somewhere…so I’m now taking oral antibiotics (again) in addition to IV antibiotics.

Oh, joy.

Taking antibiotics is no big deal. Dealing with the side effects, which can include diarrhea and yeast infections, can be. One antibiotic I took a couple of times in the past year gave me heartburn, so I had to chew a couple of those yucky, chalky, anti-heartburn tablets right before I took the drug. But they do get rid of infections. You just need to get the right antibiotic. Hopefully, the culture the doctor took yesterday will tell him what bacteria needs to be killed.

Back to insulin adjustments: It would be easy if you figured out your basal rate(s), insulin-to-carbohydrate ratio, and correction factor and it stayed the same for the rest of your life.

No such luck. Not only do insulin requirements change over the course of your life, they can change weekly or monthly or any other time period, depending on what else is going on in your life.

Those little changes didn’t seem to show up when I was injecting insulin. But when I began using an insulin pump — maybe 12 years ago? — they became noticeable.

Today’s pumps allow you to set different basal rates for different circumstances. For example, some people set one basal rate for workdays and another for their days off, when their activity levels change. Women notice that their insulin needs change depending on the time of month. It’s common to need less insulin while menstruating.

I’ve certainly noticed how insulin needs can change depending on my infection level. The couple of times I’ve had osteomyelitis (bone infection), my insulin needs have dropped when the infected bone was removed. And I mean drastically and fast!

Immediately after I had surgery last month, I dropped my basal rates by 1 unit an hour around the clock. It still wasn’t enough and the hypoglycemia came on fast. So I dropped them by another half a unit and then by tenths of units until I got it (kind of) right. I’m still fine-tuning.

I run three basal rates: one from midnight to 3 AM, one from 3 AM to 12:30 PM, and one from 12:30 PM to midnight. It’s the last one that needs a bit more tweaking.

After that, I can work on insulin-to-carbohydrate ratios (the amount of carbohydrate one unit of insulin will cover) and correction factors (the number of points one unit of insulin will lower your blood glucose). I think I pretty much have a handle on those, but will have a better idea once my basal rates are set just right. (At which point, the basal rates will likely change. Again.)

Thankfully, wearing a continuous glucose monitor (CGM) is a lot more helpful in figuring these things out than finger sticks were. I can look at the graph on my CGM to see exactly how my insulin adjustments affect my blood glucose control.

Still, it’s a bit of a hassle — especially to someone (that would be me) who doesn’t like to commit math. But totally worth it when everything is figured out and running smoothly.

Until (as I said) something happens to change things all over again.

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