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How much do insulin needs vary throughout the day?

tim2000s

tim2000s

Expert
Retired Moderator
As I've been running the hybrid closed loop for a little while now, I thought people might be interested in the variation in basal requirements over the course of a few days where activity, food and sedentariness were all very similar. It's really quite startling and gives good insight into how difficult it is to match what the body needs with the basal insulins that are part of the MDI regime.

In the picture below, the blue skyscrapers show the insulin delivered by the HCL system at any point throughout the day, by means of adjusting the basal rate. My basal rate (the dotted blue line) is already configured to take into account my insulin variation. The column on the right show the variation in Basal insulin by absolute units. There's around an 8% variation over the three days. For me what was most noticeable was the vast difference in how the loop increased and decreased insulin over the course of the day and how I needed different amounts of bolus for what amounted to similar foods that in theory shouldn't make a difference.

Anyway, enough of my waffling. It's an interesting insight into what we're trying to replicate with basal insulin!


IMG_0355_zpsyy4wscxo.png
 
I'm not surprised by this at all, I tweak my basal and bolus quantities/ratios fairly regularly as it's clear my insulin requirements vary a lot day to day, even when on paper, my activity levels and food are the same. It's like herding cats!

Its why I get very cross when DSN's and the like imply that it's all just a matter of simple maths and any problems are "user error". They seem to be under the misguided impression that all we need to do is count CHO accurately, inject the exact same bolus ratio and stick with a fixed amount of basal and it'll all be fine, no highs and no hypos. If only!

I might print out this post and bring it to my next hosp appt. as it illustrates beautifully just how much variation there is. thanks Tim!
 
Wow, thanks for this @tim2000s - I've found looking at the sheer variation very reassuring - I have a lot of ranty 'but everything was exactly the same as yesterday, so WHHHYYYYY have I gone high/low etc' moments, and this helps to explain them...

I've spent the last few days tweaking my basal to cover a new steady rise in my blood glucose from around midnight to 6am. I'm putting this down to my recently-increased evening cheese consumption - in an effort to gain weight I have added a cheeky (and generous) cheese course to my evening meal. Yum - but it hits me later!
 
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