Experiment: basal vs bolus corrections

[T1Allison]

via GIPHY

I believe carrying a touch extra basal is like greasing the bottom of your sled when it comes to getting effectiveness out of the rest of your regular meal and correction boluses.

[Michel]

@T1Allison

I believe carrying a touch extra basal is like greasing the bottom of your sled when it comes to getting effectiveness out of the rest of your regular meal and correction boluses

I love your example, it totally matches my feelings too.

[Michel]

@TiaG

I think the calculation you’d need to do is to figure out what the likely concentration of insulin in the bloodstream is at any given time with basal vs. bolus injections.

I tend to agree. As you’ll notice, the experiment I described above focuses just on that, since we waited until there was no significant IOB by waiting out the DIA for the large previous correction.

@TiaG

It’s like basal is pushing a rock up a hill slowly. Bolus is slamming the rock a few times and then it starts sliding back down before you slam it again.

This is also my intuitive thought. But I could well be wrong Either way, if this experiment can be duplicated by others, it would prove that, in one process, insulin is used much more efficiently.

[Michel]

@Thomas

You do (syringe/pen) as well as pump - correct?

Yes

@Thomas

So do you see a difference for a large injection (syringe/pen) bolus vs large pump bolus? As compared to the effectiveness of tiny trickles of insulin over longer periods (whether it be called temp basal or extended bolus or whatever)?

We do see a difference between the two. Large pump boluses tend to be less effective, and slower as well, in particular (a) when they follow other boluses, and (b) in the later days of the pump site cycle.

So, as a result, we have a rule that any injection 4.5U or above is given by pen. We even split larger injections (such as 8U for instance) into 2 pen injections in different sites.

But the difference is efficiency does not compare to the one we appear to see between basal and bolus use of insulin, though. However, I should be clear on the fact that the experiment above only shows the efficiency of basal insulin vs bolus when used with no IOB. With IOB, it could be a wholly different kettle of fish.