Insulin delivery is a key component of  mastering blood sugar balance in Type 1 diabetes.  The Basal Dosage is a component of the insulin delivery system.  There are several different types of insulin.  These types are identified primarily by the length of time they take in becoming active and by the length of time they are active. There are two two ways of delivering insulin.  One is by injection and one is by the insulin pump.  They had been working on insulin you can inhale but it recently turned out to be not workable. Whether you are using injections or the pump you must be aware of your basal level.  Your basal level is the amount of insulin you need to maintain relatively consistent (between 10 to 30 points)  blood sugar readings over a significant period of time without ingesting carbohydrates or fats starting four hours after your last meal. In the Mastering your Diabetes Course that I participated in we fasted for 24 hours in order to test our basal dosages.  If during this test blood sugars trend downward then the basal dosage is too high.  Conversely, if blood sugar readings trend upwards then the basal dosage is too low.  Often times, a person’s basal requirements may be higher or lower during specific times during the day.  For example, some people experience what is called the “Dawn Effect.”  This is when blood sugar levels rise early in the morning (4am to 6am) and therefore a higher basal dosage is needed during this time.  A good and tested basal insulin dosage is needed for achieving mastery in blood sugar balancing.  A 24 hour test is the minimum requirement needed to have a chance at getting there.  To maintain mastery one should be checking in on basal dosage needs every so often.  This is a necessary skill if one is to achieve A1C’s below 7.0.

Basal requirements will also change because of illness, stress, exercise, weight gain/loss, mood, types of food being eaten, eating patterns and probably more reasons that I am currently unable to access at this time.  To achieve “tighter”  control one should………  Wait a minute.  I am going to replace the visual and feeling of the last sentence,    “tighter control” with a different one …….”more certainty.’  This a a shift in the way to look at balancing blood sugars.  Instead of control one is looking to create certainty.  Instead of battling chaos you are focused on doubt as the opponent.  This shift in perspective increases awareness and responsibility.  The result is more control.  The objective is more certainty.  So, to achieve more certainty you should test basal with the additional factors included in the equation.  For example, I sometimes play poker.  I have noticed, through testing often, that my basal requirement when playing poker increases by at least 30%.  When I do a 3 mile run I don’t need a basal.  Depending on other factors, especially, carbohydrate intake I should probably get my blood sugar level to 165 or higher before going out for that run.  I also must be vigilant in 12 hours after running as my basal requirement may be lower.  A real interesting example is when I went away to a 10 day meditation course.  My activity level was significantly reduced, my diet changed a bit and I was meditating 12 hours/day.  My basal level reduced by 40% while at this course.  I was amazed.  You can read more about it in a previous blog I wrote about the meditation experience.

I believe that to create more certainty one should be always seeking the lowest denominator in terms of the basal dosage.  In other words, you should be taking the least amount of insulin you can in the form of basal.  Think about it.  Someone with a 10 unit per hour basal compared to someone with a 1 unit per hour basal has less certainty.  Doctors and others involved with Diabetes education may not agree with me here.  But it is true that a .5 of a unit shift is a much more significant change for the person with a lower requirement.  I look at insulin like an accelerator in a car.  The tighter the accelerator the more confidence you have in what the car will do;  the more responsive it is.  I am always trying to reduce my basal.  I do this by testing a lot in many situations especially 4 hours post meal and forward.

Good Luck

I think that mastering blood sugar control is a good and necessary step in the process of being a Type 1 diabetic.  In fact, if you can master blood sugar control then you have achieved a high summit in the climb to the top. But mastery is not the top.   Let’s step back and define mastery of blood sugar control.  For those of you who have Type 1 diabetes you know that it does not mean that you have normal blood sugar results at all times.  That is impossible, at least in my experience.  Mastery, in my opinion, is A1C readings below 7 with very few lows.  For those of you not aware of what an A1C is …it is a blood test that measures a person’s average blood sugar level for the past three months.  For a non diabetic the reading should be below 6.0.  This means the average blood sugar was 120.  An A1c between 6.0 and 6.5 is what I shoot for.  6.5 = average blood sugar of 136. Again,  I define mastery as anything below 7 which = 150.  Below 7 is the point at which most researchers are saying that risk of complications can be drastically reduced.  Anything above 7 means that more work is to be done before one can claim mastery.  But mastery over blood sugar control as a Type 1 diabetic is not the top of the mountain.  I have achieved consistent A1C results below 7 for 2 years now and I have begun the ascent upward.  I have used words such as conquer, liberate, heal, and triumph to describe this next step but none of them have captured the true essence of it yet.  I want to eliminate it as an issue for me to deal with at all.  Perhaps this is not possible but, nevertheless, I have decided to take the journey and check it out.  I know this much…….  There is climbing to be done above mastery.

So, I said in my last post that my next post would be an assessment of the 5 day training I participated in at the Diabetes Research Institute in Miami, Fl.  I have been struggling with writing it and have not decided on the approach I wish to take but I want to write this post so that I can move on.  I do feel a bit stuck after the course.  I learned some things and I was able to connect to others who are dealing with the disease but it seemed to end and did not have a sustaining effect.  I am sure that others at the course got a lot out of it as they were able to fill voids in what they did not know.  Nevertheless, I give the training an 8 out of 10.  It covered the foundational issues and offered advanced techniques in controlling blood sugars.  In addition, it had an effective psychological perspective built into it.  I believe that there is ongoing process of acceptance that is dealt with by the Type 1 diabetic.  Perhaps some experience it differently.  Perhaps some have the ability to go through the process and be done with it.  I Accept it! Period!  I seem to been unable to do that.  There remains remnants of not accepting it and wanting it to be otherwise.  To a large degree this has probably held me back.  However, a different perspective may see that this attitude may have steered me in a direction that has brought me here today.  I have always wanted to not have diabetes since I got it.  I guess one way to do that is to continue to search for a path that resolves my desire.  Perhaps this is the true path of healing, at least for me.  Anyways, I have done it.  I have written the assessment.  It is not the assessment that I thought I would write.  No, I thought I would write with more detail on this.

I feel it is time to move past the course.  In the end, I recommend this course for anyone with Type 1 Diabetes and family members.  It is tremendously informative and the people who run the course are good and compassionate people.  The course materials offer the best foundational springboard for anyone dealing with this disease who does not have a springboard in place.  The better the springboard the easier to get up on the high wire of blood sugar control.  Education and knowledge and skill development is critical.  But remember that you can only hold and utilize the knowledge and skills that you possess in the container that you have built to hold such thing.  Your container has several sides to it.  They are all made of thought and the final vessel is the combination and strength of those thoughts;  Your Attitude.  To become conscious of your current Attitude and to begin building a new vessel, if that is what you wish to do, then contemplate words such as …………..opinions, facts, beliefs, feelings, intentions, fears, strengths, weaknesses, needs, wants, expectations, desires, demands, fantasies, prejudices, habits and faith.  Till next time…….Michael

So, I am taking this course down in Miami called “Mastering Your Diabetes.”  It is offered by the The Diabetes Research Foundation(DRI).  I am in day 2 of 5.  I mentioned this blog site to the participants and staff and hope they read some of the postings.  I became a bit emotional today as we were all interacting and sharing more about our individual stories regarding diabetes.  There is a 14 year old boy who has Type 1 diabetes.  He is from Columbia and is a star soccer player.  He looks a lot like a looked when I was 14 and diagnosed.  At that time I was a star soccer player. Or, at least I would like to think so.  I became emotional when his mother who is with him through the whole course began to speak of her son and how well he is dealing with his condition.  She went further and spoke of his younger brother who has been with him in the past during his insulin pump training and his desire to support his older brother with diabetes.  As I was driving home I reviewed this morning’s events and my emotional response and came up with three reasons(thoughts) I was having at the time.  First, I was seeing myself in him.  I am 46 years old and at the same time I am feeling intensely myself as a 14 year old being diagnosed with Type 1 diabetes.  Second, I was feeling the mother’s love for her son and I was, at the same time, feeling the love I have and the tremendous support I received from my Mom.  I saw and felt her courage, her compassion as well as her uncertainty and fear.  I sympathized with her and I admired her.  But, most of all I thought of this boy’s little brother and I felt the closeness they must have and the pain they must feel.  And, I thought of my brother who was and is the same way.  As I write this I am allowing myself to feel the full brunt of emotion that was beginning to break through this morning but I would not allow to come through completely.   Let’s see what the next three days bring.  My next posting will be a final assessment of the course.