Graphing Insulin Receptor Up/Down Regulation

Excel worksheet, to track the state of Insulin Receptor Up/Down Regulation of a T1D using a weighted running average (Reference TDD) over the last 14 days.

light blue area = TDD, darker blue area = total basal insulin per day. dashed Lines: red/blue/green = 3/7/14 day moving avg. solid lines: Light blue = reference TDD, darker blue = reference Basal calculated from that by applying an individuall percentage to the reference TDD. light green background: non-working days horizontal scale: time-series with a one-day resolution

ToDo: explain receptor up/down regulation.

For a start: The general lay of your insulin sensitivity depends on the amount of insulin the body is “used to”.

Insulin Receptor Down Regulation: Using more insulin over a consecutive number of days, regardless of the reason. (sickness, medication, less sport, multi-day-feasting, whatever), de-sensitizes your reaction to insulin in general, i.e. an increased Insulin Resistance.

Insulin Receptor Up Regulation: This can be reversed by using less insulin over a consecutive number of days - more activity, less carbs, etc.

Getting started with the worksheet

The first 14 days are needed to get the weighted average calculation up and running with valid data.

• In [Data]17B you enter the Date of the first day of your series of TDD data (Total daily insulin, meaning all insulin injected during that day, basal, bolus (meal bolus and correction bolus).
• you then enter the first 14 days of TDD into Column J to get the weighted average calculations initialized
• on the Sheet [BR], you need to enter your individual divisor for your TDD/total BR ratio. The default is set to 2, resulting in the dark blue line delineating a reference basal sum of 50% of the reference TDD. YDMV, and is best determined by basal-rate testing during a time of stable TDDs. (caveat: basal-rate testing usually lowers your TDD on the day of the test. Testing on consecutive days most likely starts a more or less pronounced Up-Regulation, influencing the results of the test.

Daily entries:

Starting line 31 in the “data” sheet, you enter

• J Total daily insulin - as collected from the pump (ICT users can change this to a calculation adding data from the bolus and basal columns). This is the only column needed for the sheet to work.
• I Sum of Basal Insulin (either from profile, or -better- taking TBR into account, from nightscout)
• H (optional) sum of corrective bolus insulin (hard to isolate in closed loop setups). Can alternatively be used for carbs/day, or even for other tdd-raising entities, such as cortisol dosis.
• Q (up to two) single letter Events affecting the TDD or your interptretation (Set change, Illness, whatever is relevant to you). In the samples, K is used for set change, D/U for interpretation as Up or Down indicator according to a ruleset published by Dr. Teupe.
• G (optional) Bolus insulin , currently disabled from graph.
• A used to mark non-working days in the graph (could be used for training days, whatever you want to stand out): 0: Day is displayed with a green background in the graph. Not relevant for calculations

Bibliography

Die Logik meines Diabetes : [Insulinpumpen-Therapiewissen; Behandlung diabetischer Fußleiden; 30Jahre Erfahrung als Handbuch] / Bernhard Teupe. - 1. Aufl..