The Genius of Intuition

There is something I just don’t get yet. For as long as we’ve been administering Lia’s insulin through a pump we routinely find ourselves relying on intuition when determining her dose. A word problem of how this happens might look something like this:

Lia and her dad are on a field trip to visit a Native American settlement that had been founded and recreated along the banks of a very old river. It is a three hour car ride from school, for which they program a +30% temp basal. They arrive and while watching a documentary film of the tribe, Lia indicates she’s feeling shaky. Fearing a low, they apply an alcohol swab to her finger and check her blood. It reads 331. To bring it down, the pump suggests a dose of 4.10 units of insulin. The two of them talk and decide that 4 units is just too much, especially for the way she is feeling. They agree on a dose half that number. They finish the film and go outside and stand in the rain to watch a demonstration of primitive hunting, after which it is lunchtime. Ninety minutes has passed since Lia received the dose. Before eating, she checks her blood and the meter reads 64. Lia and her dad share a perplexed look with one another. With almost one full unit of insulin still on board, what might have happened had they given the full amount?

It may be that Lia is still honeymooning, though her endocrinologist thinks not. It may be the first reading was just wrong, perhaps her finger wasn’t cleaned properly, maybe it was a meter accuracy issue.

Or it could be that treating diabetes isn’t really just a matter of science. It requires more than mathematical logic and the relationship of quantity, patterns and conjecture, but must also take into account the most primitive and genius of the human condition, the element of instinct.

Not to take anything away from science. It is science that made the field trip that Lia and I were on even possible, without it the village would’ve stayed lost forever. But just as emotion and intuition were certainly a part of the people of that great settlement, and possibly even its demise, I wonder where in the complex world of artificial re-creation does the word hunch fit in.

On November 14, World Diabetes Day, Juvenile Diabetes Resource Foundation Advocacy is hosting Type 1 Talk in an effort to bring type 1 communities together from across the country for a lively and engaging discussion on various pertinent topics. To join the talk on Facebook and host or find your own Type 1 Talk event click here.

If you too use intuition for treating diabetes and would like to suggest your own question for the moderator or cast your vote for Without Envy’s suggestion, click here before the end of the day today, October 22, and under topics search: emotion.

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5 Responses to The Genius of Intuition

  1. Patricia Debney January 23, 2011 at 12:32 pm #

    Hi Steve

    I know this is an old post – I’m catching up with you too! But if you find this happening a lot, maybe it’s a thought to look at what the insulin sensitivity is set on? It could be that the pump is set up to calculate incorrectly? We’ve adjusted E’s up or down two or three times in the last 18 months. Clues for us have been going too low consistently after corrections/meal boluses (different meals at different times of day, as opposed to one consistent meal which would indicate a ratio problem)…OR taking corrections which don’t do the whole job and make him seem really insulin resistant… We have found sensitivity the absolute hardest thing to land upon as being a possible cause for odd numbers… We also have sensitivity set at different things for different times of day…

    Like others here, we rarely override the pump — usually only in extremis: insulin resistance, or lots of exercise that a temp can’t tackle quickly enough…

    p

  2. Sara Fincham October 24, 2010 at 10:53 pm #

    I hate it when there is a “what tha’…” moment in the numbers…the biggest problem is you’ll NEVER know!? It seems like there would be no way the insulin could have peaked and dropped her numbers that far that fast, but I know everyone is different when it comes to the action time of insulin. Sometimes Ellie’s little body almost acts like it holds the insulin back for a little longer than usual and boom! all the sudden she’s dropping…30 minutes after I did a correction.
    I would say from what I’ve read…between the improvements on the CGM technology (accuracy) and the quest for faster acting insulin (which I’ll take without the artificial pancreas) the control or accuracy will come in the ability to see results of your actions much quicker…like you though I do agree that a lot of intuition goes into the management of diabetes…we must not forget that when the marketers get started with the selling of these gizmos! (Although, I assume they know there will be an error factor by adding the glucagon to the artificial pancreas to correct quickly when those “what tha…” events happen…even our bodies must make small errors…the liver corrects too???) You never did say how the CGM did for Lia when she tried it for a week? Either way hope it was of help?!

  3. Wendy October 23, 2010 at 3:24 am #

    I would say that I trust the pump the overwhelming majority of the time. BUT….it took a good 3 years before I felt that confident.

    There are times that I just **know** that I’ll need to tweak the dose a little.

    Maybe the Artificial Pancreas will be better?

  4. Reyna Maher October 22, 2010 at 8:36 pm #

    Yep…totally “hunching” it over here! I usually go with Joe’s pump settings…however, in unique circumstances I will over-ride them. Like today, for instance, we were at the movies. I cranked up the basal by 80% AND gave an extra 10% of insulin with boluses. I am fortunate b/c I have the Dexcom CGM to watch while I also watch the movie (LOL)…I have to say I did a pretty good job today…90-220 at the movies!!! WOOT…I feel like I won an Academy Award. Joe used to go up to the 400s at the movies…The CGM has helped me be a little more “ballsy” with what I am willing to try with dosing insulin.

  5. Penny October 22, 2010 at 8:01 pm #

    I think we as DMommas and DDads rely on hunches often to guide us in this journey. That being said, I do trust my daughter’s pump and cannot think of the last time I second guessed it. I learned from Gary Scheiner, my daughter’s CDE, that if we have basal tested and really gotten some good basal rates to move forth with, then tried and tested different I:C ratios, I don’t worry about the dose, it takes care of it. Whenever I see the crazy numbers, I go straight back to basal testing and if that is ok, right to I:C ratios. I use temp basals and extended boluses to take care of big meals and slow GI foods. That helps a lot.
    Where I am stuck on hunches is with carb-guessing foods I don’t know, that is a total hunch some days!

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