help with basal testing

[rachk]

I'm really frustrated because my blood sugars keep screwing me over when I want to exercise. For example, today I was 91 so I ate a protein bar with 23 carbs and lowered my basal rate for an hour and a half to raise my blood sugar so I could exercise. Half an hour later I was 101 and an hour later I was 108. There's no way I could exercise at that. I would have to eat more, which I didn't want to do. Since I ate and my blood sugar barely moved, I'm assuming maybe my basals are off so I have a renewed motivation to really get my basals figured out. My morning and overnight sugars have been a little wacky lately too. I want to do some basal testing, but need some help.

Do you just pick one part of the day and test that for 3 days? Like do a morning fast for 3 days? Then the next 3 days do the afternoon, etc.? If I don't have a CGMS, how often should I wake to do tests overnight?

Anything else helpful I should know? Sorry if this seems really basic!

[ant hill]

Test before you eat and see that you get 6 / 100 Then have your bolus.
Good luck. :)

[HollyB]

I was told it takes one to two hours to see the effect in a change of basal rate. So maybe try lowering your basal two hours before exercising. Experiment with how much -- some people lower just a little, some 50% or more.

I'm not sure what's in a protein bar but it sounds like it might not affect your BG for some time after eating. So maybe it would be good for helping your BG hold steady while you exercise, but maybe not so good for boosting it up to an optimal level to start with. Something that's more just fast carb might be more the ticket there.

[duck]

I'm really frustrated because my blood sugars keep screwing me over when I want to exercise. For example, today I was 91 so I ate a protein bar with 23 carbs and lowered my basal rate for an hour and a half to raise my blood sugar so I could exercise. Half an hour later I was 101 and an hour later I was 108. There's no way I could exercise at that. I would have to eat more, which I didn't want to do. Since I ate and my blood sugar barely moved, I'm assuming maybe my basals are off so I have a renewed motivation to really get my basals figured out. My morning and overnight sugars have been a little wacky lately too. I want to do some basal testing, but need some help.

Do you just pick one part of the day and test that for 3 days? Like do a morning fast for 3 days? Then the next 3 days do the afternoon, etc.? If I don't have a CGMS, how often should I wake to do tests overnight?

Anything else helpful I should know? Sorry if this seems really basic!

Rachk, this isn't "criticism", this is me typing stream-of-conscience like I would *think* if I were posing these questions to myself (in other words, I'm "talking" like I would if no one else could hear, LOL):

One weird day does not a pattern make.

Protein bar probably wasn't the best antidote for a low, there's a reason why Glucose tabs are recommended--they are tried and true. If you had popped 15-30 grams of glucose and had the same results, we wouldn't be dealing with the conjecture of "maybe the protein or other ingredients slowed digestion of th 23 grams of carb..."

What happened to your sugars three hours after the bar? Four?


Now, as far as basal testing, again, one day does not a pattern make, but basal testing is no fun so if anyone told me they were only going to do it one day, I wouldn't call them a name. But, two or three days of same-time-period testing would make more sense to see a pattern.

Basically, you have to have NOT eaten ANYTHING or bolused ANYTHING (except basal) for the preceding four hours before commencing a basal test. To do it properly, your blood sugars should be between 100-140, and once the test begins, if your sugars ever drop below 80 or rise about 160, quit and correct and attack it again some other time.

Also, no exercise leading up to the tests, if at all possible. Nothing strenuous during, either.

Try to go as long as you can. If it were me, I'd test every half hour, using clean finger-tips.

[xMenace]

Fast acting insulin lasts 6 hours and I try to get a 6 hour stretch, 5 at least. I know it's tough but I've seen my sugars plummet after 4 hours after a steep rise. Simply uping my dosage would have sent me into danger. Cases like this require shifting doses, not simply adding or subtracting.

Hourly testing is fine, but I prefer 1/2 hour intervals. For overnight pick only one hour a night and spend a week on it. Try to make your pre-bedtime rituals the same. It's no fun.

Here's some links. The PDF is a great guide.

Timings:
Index of Diabetes Technology pages: Insulin Pumps, Insulin Pump Comparison, Blood Sugar Meters, continuous glucose monitoring devices, noninvasive monitoring, diabetes software. (http://www.diabetesnet.com/diabetes_technology/dia.php)
Articles:
Integrated Diabetes Services - Diabetes Management (http://www.integrateddiabetes.com/pump_bt.shtml)
Diabetes Self Management (http://www.diabetesselfmanagement.com/article.cfm?aid=2161)
HOWTO profile your Basal Rates. (http://www.insulin-pumpers.org/howto/baslr.html)
PDF Worksheet with instructions:
http://www.centremedsurg.com/Forms/Basal%20Rate%20Worksheets.pdf

[rachk]

Thanks for all the tips - very helpful! But now I know why I've never done basal tests before - I miss it when I can't eat! :) Duck: you said try to go as long as I can - like a whole day or more than a day?

I've always eaten a protein bar before I run and hadn't actually considered the protein slowing the absorption of the carbs. If my sugars are a little higher, it usually works just fine and my sugars are okay after I run - sometimes a bit low. I'll have to consider this and figure out something better to eat before exercising. I also wouldn't normally treat a 91 as a low, but I guess I should have before exercising. It's also hard for me to really plan ahead when I'm going to exercise so I never know when to lower my basal to prepare. But I guess this is all more on the topic of exercise!

[rzrbks]

rachk,

I go 16-18 hours without eating when I check basal.

Inject Lantus at 11:30 pm:

Do first check when I get up

then check every 1-2 hours as long as I can stand going without eating.

I generally do this on week-ends when I KNOW that I won't have to do anything physically demanding.

Although I sometimes do checks on work days when I know it'll be slow enough that there is no way I'll have to do excessive physical activities.

[Cyborg]

For most people, anaerobic exercise will actually increase bg. Aerobic exercise usually lowers bg. Both forms of exercise are beneficial for diabetics...

[duck]

I'd rather pull my teeth out than not eat all day...also, after some time (and I know that is VERY scientific), your body might say "Holy ****, we haven't had food in X hours--INJECT GLUCOSE, MR. LIVER!" Which is a good sign, actually, but bad for basal testing.

I never made it more than four hours into basal testing (eight hours after my last meal and bolus). But I'm also not a tough guy like that dude Rzr. :D

[ant hill]

If you test more than 6 tests a day is enough to get a good graph so over say 10 days 60 tests then add up the tests then divide the total by 60 and that would give your average.
Or get your tests in the computer with software to do these calculations for you. ;)

[rachk]

I'd rather pull my teeth out than not eat all day...also, after some time (and I know that is VERY scientific), your body might say "Holy ****, we haven't had food in X hours--INJECT GLUCOSE, MR. LIVER!" Which is a good sign, actually, but bad for basal testing.

I never made it more than four hours into basal testing (eight hours after my last meal and bolus). But I'm also not a tough guy like that dude Rzr. :D

Me too! I always feel cheated if I miss a meal. :) Plus, it just makes me feel 'off.' Today was horrible. I was fine until about 8 hours after not eating. I got a really bad headache so I decided to eat a little early, but I felt sick when I ate and then I felt like **** for about 4 hours after that. Felt like a waste of a day! So I think my new plan is to just do shorter intervals. My sugars aren't way off or anything so I'm not concerned. I just figured I'd fine tune everything. As for the liver response to not eating, I'm not sure what you mean by that. Do you mean that it might cause your blood sugars to be off? If so, that didn't seem to happen in me. My sugars were very consistent and have continued to be consistent throughout the evening.

[nissen99]

Not sure if this would help, but my son just started football practice and I asked his diabetes team what he should eat, when, etc. before practice. It was suggested that he have a peanut butter sandwich about 30 minutes or so before practice and take no bolus with it. The protein helps with the spiking and the carbs from the bread keep the sugars high enough during the exercise.

[rzrbks]

As for the liver response to not eating, I'm not sure what you mean by that. Do you mean that it might cause your blood sugars to be off? If so, that didn't seem to happen in me. My sugars were very consistent and have continued to be consistent throughout the evening.

Yep, one of the things that can throw off your test results is that your liver can cause an insulin "dump" (it just pumps some in) and your B/G starts climbing for no apparent reason.

One explaination of liver dump:


A liver dump during the day is because you've exercised or not eaten, and
your liver has noticed; it produces a surge of glucose to bring you back to
full function. Normally this surge is turned off, and any excess glucose
absorbed, by an insulin reaction; but diabetics can't do that very well, or
very quickly.