Basal setting

[carolyn]

Can anyone help me to work out my basal level. I have tried a few tests but I am just getting muddled up. Please help if you can. Thanx:confused: :confused:

[Cyborg]

Here's (http://www.insulin-pumpers.org/howto/baslr.html) a good link on how to profile your basals.

[Geoff]

Hi Carolyn, please give us some information so that we can help. example, weight, how many units of basal insulin you take, what other insulin your are using, when you take, and a bit more info on where you are going wrong.

[SueM]

Carolyn, Sorry I can't help you re your basal, but surely your diabetes team is meant to be doing this.
It's pointless giving you a pump if they havent worked things out and made you part of the team for your care.
Hope you are sorted soon.

[AMBlass]

Carolyn,

This is a link to my CDE's website that has instructions for how to do a basal testing.

Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/pump_bt.shtml)

I usually do a test like this: For my morning basal rates, I wake up, test early at 8 am, and keep testing every 2 hours until lunch. For the afternoons, I eat breakfast, skip lunch, and test every 2 hours throughout the afternoon and then eat dinner. For my evening basals, I eat lunch, and then start my tests at 4pm and test every 2 hours until I'm about to go to bed and then eat right before I sleep. And then for overnight, I eat dinner, and then test at bedtime, 2 am, 4 am, and 6 am and then wake up at 8 am.

Do NOT do more than one basal test a day. If you do, you will go low from the fasting. Nondiabetics will go low if they don't eat for an extended period of time, so your readings will be affected from that if you go too long without eating.

Once you have the readings, send them to your CDE or endo and they will be able to make adjustments. Since none of us are medical providers, no one on the board should tell you what specifically needs to be changed.

Geoff, if she is on an insulin pump, she should not be taking any other insulin at all. The only addition hormone that is advisable is Symlin or Byetta.

I'll also add that even if you have been on an insulin pump for years and have had adequate training and experience, basal rates and bolus ratios fluctuate periodically and adjustments will have to be made. Knowing how to make those adjustments are not easy and should be made under medical advisement.

Hope this helps! Cheers!

[Geoff]

Hi AmBlass I think your advice is very good. But just to note Carolyn lives in the UK. Statistically there are +- 30,000 type 1 diabetics out of a diabetic population of 3,000,000 diabetics in the UK. Out of that number there are no more than 3,000 on a pump. So it is normal for me to assume that she is not one of them.

Also due to heavy cuts in the health service, CDE's and endo's are spread pretty thin. In fact guide lines from our health service tell diabetics that they are empowered to manage their diabetes through knowledge and experience. so in other words you are very much on your own. There are exceptions to this rule, but in genera,l forums like this one are the best form of advice, based on informed decision.

[sofaraway]

have you started on the pump carolyn? or are you trying to work out your basal needs before starting?

post the results of the tests you have done and maybe we can help

[xMenace]

The same techniques can be used for MDI regemines; however, the goal of achieving steady basal sugars is not as straightforward. You'll experience ups and downs that may have to be treated with additional doses of short acting insulin or with food. The important thing is to do these tests and find out what your basal profile looks like so you can try different matching strategies.

AMblass - nice link. Kudos to your CDE. One suggestion though: tests should be done every hour or even half hour, not every 2 hours. Nighttime is different; you need sleep. Test every four hours and stagger times over many nights to build a composite profile.

[xMenace]

Carolyn, Sorry I can't help you re your basal, but surely your diabetes team is meant to be doing this.
It's pointless giving you a pump if they havent worked things out and made you part of the team for your care.
Hope you are sorted soon.

I left my DE's totally unarmed to set rates. When I showed my DE and Endo my work, it was the first time they'd ever seen this kind of profiling. My DE was very skeptical and my endo lauded it. What pisses me off is all the non or bad advice other diabetics are getting.

[AMBlass]

For daytime readings, blood sugar tests should be done every 1-2 hours. I usually still do every 2 hours overnight, but John Walsh in pumping insulin does says this, "Monitor your glucose every 1-2 hours (or at 0, 4, and 8 hours for an overnight basal test.)" So I guess we are both right as far as frequency of testing, though I still think testing every half an hour is ridiculous. Not only is it a total waste of strips, but I don't think you gain much information between half an hour and an hour.

So I guess an overnight basal test would look like this:

Eat dinner at 6pm. Do not bolus or eat past that. Test at midnight, test at 4 a.m. and test at 8 a.m. If you rise more than 30 points or drop more than 30 points between start and finish, your basals need tweaking.

Of course, I did not consider she might mean Lantus, so she will have to clarify that.

[grace girl]

Actually, in John Walch's book Using Insulin he suggests very similar tests for basals for those on Lantus as those on the pump do. It's true, you can't get it as fine-tuned with Lantus as a pump, but with dilligent testing you know what it's doing when, and it is fairly simple to work with it. You also avoid a whole lot of unnecessary hypos/and or highs that way.

I use lantus, and I've done the night test, and both daytime tests. The results of those tests are the most valuable information I've had since I've been on insulin.

[xMenace]

I still think testing every half an hour is ridiculous. Not only is it a total waste of strips, but I don't think you gain much information between half an hour and an hour.



And CGMSs are a waste of money. Information is Power!

red=bg, green=bolus, yellow=basal, flat green=0, bolus at 12pm, ate at 12:30pm, skipped breakfast, correction at 4pm, skipped supper.

[AMBlass]

I'm just saying, if every half hour was really necessary, John Walsh would have said so in his book. He's the expert in pumping and his book says "Monitor every 1-2 hours."

[xMenace]

Isn't he American? His book is likely tailored towards Americans who have to deal with anal inusrance companies, endos, and pharmacists. I'm in Canada with a free, unlimited supply of strips.

For straight basal testing, I agree every hour or two is fine. That's what I typically do do. But when you throw food, insulin, and whatever else into the mix, it does have paybacks. I've discovered my BGs rise significantly that quickly after eating and that I've proven Humalog doesn't start working immediately on me, and very unlikely on anyone else. I've also seen very quick drops as my insulin peaks pass and a common overdose situation between hours 4 and 6. There are many times, like right now when I'm about to drive home in rain, that I want to know exactly what's happenning. I sincerely do find 1/2 hr profiling a useful exercise.

[AMBlass]

John Walsh is American, but I don't think that has anything to do with his recommendations on basal testing. I think it's pretty much common sense. For example:

If you can see during your basal test that you are rising rapidly or dropping rapidly, obviously you'll want to test more often to prevent that from happening. But, logically, there is very little difference between half hour tests and hour tests. Both are going to show a rise or a drop, and the difference in mg/dl points is going to be very little, unless of course you are rising rapidly or dropping rapidly. You're still going to be able to see your trend, and you'll still be able to pinpoint when it occurs. Because you have to change your basal rate *several hours* before the blood sugar fluctuation actually occurs, narrowing it down to a specific half hour time frame really doesn't do much good. If you don't see much of a rise between 1:30 and 2:00, but you do see a rise between 2:00 and 2:30, then logically you wouldn't see much of a rise between 1:00 and 2:00, but there would be a rise between 2:00 and 3:00.

Because of basal lag time (at such small doses, you'd actually need several hours worth of basals to make a dent in a blood sugar), you would actually want to change your basal rate around 11:00 a.m. Having it narrowed down to the half hour really doesn't give you much of an added advantage in make that adjustment, even two hours could give you enough information about when you're rising to make the changes.

Obviously food, insulin, exercise, stress, the weather, etc. has effects on blood sugar and that's when the CGMS is nice for some people. I'm not going to argue with you about what makes you comfortable and less stressed. That would be irresponsible of me as a Type 1 diabetic to tell anyone, "No, you shouldn't test when you feel you need to." Duh, of course you can. My point was that as far as basal rate testing goes, it's not necessary. Even 1/2 hour profiling isn't excessive unless you are hitting a point when you know that your blood sugars fluctuate rapidly. Almost everyone has a rise in blood sugars before the Humalog kicks in. It starts "working" around 15-20 minutes after injecting, the peak isn't until 1 or 1 1/2 hours after injecting, and it's action can last up to 4 to 6 hours. Food hits your system almost immediately. So it's tricky. You might actually want to look at your bolus ratios. You might be hitting it a little heavy.