So: as a surrogate pancreas you’ve got to get familiarize yourself with what one does. That’s how you’ll understand the difference between basal and bolus insulin.
Typical Pancreatic Activity
When we sleep (and are not eating), the liver releases some of its stores of glycogen into the bloodstream, to give the brain the energy it needs. In a normal pancreas, insulin is released slowly and continuously. It does this to keep blood glucose levels in balance. Blood glucose levels would rise without this continuous supply of insulin.
When a meal is eaten, the pancreas emits a larger amount of insulin to keep pace with the blood glucose that is being released into the bloodstream from the process of digestion.
All of this activity keeps the person without type one diabetes and without insulin resistance at blood glucose levels that range from 65 mg/DL to 150 mg/DL.
To Treat Type One Diabetes
You’ve got to imitate the pancreas. Your child will have two types of insulin. Basal insulin is like the continuous supply of insulin while bolus is what happens around eating. Basal is “extended release” insulin while bolus is “fast-acting” insulin.
Basal insulin starts working within an hour of injection and will has a12 to 24 hour activity duration in the body. Bolus insulin starts to work within 15 minutes of injection and lasts about 4 hours. It is at its peak at around 1 1/2 to 2 hours after injection. Bolus insulin is given when your child has eaten anything with carbohydrates or when his/her insulin level is high.
How much?
Basal insulin
Your endocrinologist will prescribe the amount of basal insulin your child receives based on your child’s age and weight. It will also be based on a week’s worth of multiple night-time blood glucose readings. The basal levels will be adjusted so that your child’s blood sugar readings don’t get too high or too low at night. Your team will also review and change basal insulin levels based on your child’s rate of growth or if your child gets sick.
Bolus insulin
Figuring out the amount of bolus insulin is a little tricky. This is because every person metabolizes food a little differently and needs can change based on exercise levels, food intake, overall health and even the amount of sleep your child has.
Record keeping is part of the challenge here and seeing patterns in your child’s blood sugar readings before eating is also important. Also, if you need help, call your child’s physician.
The things that go into the calculations of how much insulin your child gets in a bolus is:
1) Blood sugar reading prior to injection
2) Amount of carbs about to be eaten
3) Amount of time since last injection of insulin
4) Environmental factors: sickness, activity levels, weather (warm or cold)
The Dario glucose monitoring system can help you keep track of all of this and even calculate the amount of bolus insulin that your child needs.
Remember, it’s not easy being a surrogate pancreas. You are doing the best you can!