Assess, anticipate, calculate… and don´t forget to feel.
How do you manage what hardworking beta cells and several factors manage unnoticed by you in your body if you were not a type 1 diabetic…
As a pen and ICT user you do it approximately like this:
You inject basal insulin that provides the basic care of your body one to three times a day. If necessary, you adjust the basal rate to current circumstances, such as physical activity.
In adition to this is what makes things a little more complicated: the calculation of your bolus insulin, which is responsible for the processing of your meals and for corrections if you have high blood sugar levels. You do
each of these tailored calculations several times a day.
I often see pictures like this. They are mostly spread in diabetes realms by people who became diabetic rather recently and think that they are facing a wall. But it fits for all diabetics. The image shows a bit of despair. And humour. For it is not as complicated as it seems. Or is it?
Let’s make it concrete:
The picture and similar images show why a diabetic rarely accesses immediately when the delicious food is fresh on the table. He/she is sitting in front of it at first and seems to be lost to outsiders in an unknown world. Probably, this or something similar is felt by those who ask you why you don´t eat, why you don´t access immediately or if you don´t like about what lies there on the plate. But you are celebrating neither your nonexistent revulsion against the temptation in front of your eyes, yet you lead an inner prayer, and certainly not you meditate all of a sudden. Unless you are a fetishist of numbers and like to meditate about number sequences… probably a rare combination. But that is exactly what these five to fifteen seconds are about before you go for a knife and fork, while all the others at the table – lousy table manners assumed – dine and drink already without you: It’s all about numbers. You are not meditating. You are analyzing and calculating. Amongst other things.
Assess, feel, foresee
In order that you know how much bolus insulin your body needs to process the meal, you estimate how much carbs are on the table in front of you. You do this for each component of the meal, including drinks. There are “visible” carbohydrates such as potatoes, pasta, vegetables, bread, fruit juices, and there are “invisible” ones. So you’re going to ask yourself if and how much sugar may be hidden in the sauce or the sausages. Let´s think of eating out: by this time you know that you notice the evaluating at a vegetarian or mediterranean restaurant usually easy. It is more difficult or even impossible for example for Chinese or French food. Why is that? It is precisely these invisible carbohydrates, for Chinese, French and other cuisines are usually riddled with hidden sugar components. In the sauce or where ever. Such meals are rarely really calculable.
How ever being weighed: You’ve done this first small part of your task. You now have either a rough conjecture, a reasonably reliable estimate or the safe number of carbs that you’re going to eat and drink.
Now you’re clarifying a few other things. They all serve to your improved assessment of the necessary insulin delivery. I’m simplifying a bit:
- You consider your current blood glucose value, that you have the best checked prior to the take a seat at the table, so that your warm plate will not mutate into a cold dish within the time of consideration.
- And if you are experienced and very careful, you reflect briefly also on the probable point of this value on your imaginary blood sugar curve. For a single blood glucose value in itself can fool you hugely.
By the way you deal with the following parameters on top:
- The time of day
- The duration of effect and response curve of all the different meal components
(here, alongside carbohydrates, fats, for example, are playing a role)
- Your current physical and mental status, perhaps even your state of soul
- The time elapsed since your last meal
- The time that you will spend at this table wherewith
- Is this fast food or a 4-hour gluttony?
- Are there several menu courses?
- Do I know the host will surprise after dinner with crème brulee or chocolate mousse or beer, whiskey or sugar liqueur binge?
- Anyway: Do I drink alcohol here?
- Did I exercise extensively before dinner or will I work out after?
- Do I enjoy this meal under the sun in 40 degrees of heat, or do I sit in a German kitchen in the gray autumn cold?
- And so on. The complete list of possible things to be considered is always individual and in all cases too long for a blogpost.
You will come to a result like this or the like (differs in detail according to personal method):
- At some point, you realised the carbohydrate number that you convert into a calculating parameter, such as carbohydrate unit for example. If you haven´t assessed the same meal with this parameter from the very first beginning, which is the norm after some time experienced with diabetes.
- Now you multiply with the day time factor and get the number of insulin units you will inject in a moment.
- And you decide whether you will shoot a little more or less according to the parameters mentioned above,
or taking into account even other parameters.
Done. You inject. And grab for the silverware.
It’s that simple ;-)
Summarized and seen superficially the ICT* is only about
- the fundamental basis adjustment by one to three stitches per day
- the bolus calculation for the current meal.
It´s similar with the CSII* and pump. But completely different. See part 2.
* ICT = Intensified conventional therapy, CSII = Continuous subcutaneous insulin infusion
Made with ♡ in Germany