How to do Basal Testing

[T1snce5yo]

Hi everyone!

I have been a lurker for a few weeks now and have finally got the nerve up to post. :o I have learned some good things but I have a few questions. I have been reading pumping insulin 4th edition but am still a little confused.

First, I have been T1 since I was 5 yo (now 23) and have been on a pump since 15 yo so 8 yrs now. My control has never been good but have recently decided it was time to get it under control. I have a 5 yo daughter and it scares the heck out of me because that's the age when I got it.

My main problem right now is basal testing. I'm not sure if I'm doing it right or not. I did one overnight test and found that when I started my BG was 167 and gradually kept dropping so that when I woke at 6 am my BG was 60. I can never seem to tell if it's my basal that is off or if it is my boluses. Today I ate 77 carbs for lunch (my before and after lunch BG's have been really good lately) and I bolused right at the start of my meal. My starting BG was 139.
2 hrs later 152
3hrs later 118
4hrs later 81

So with this info I can't tell if my carb ratio is too high or if maybe my basal rate for this time period is too high. I ate a small snack (Glucerna bar) at 4hrs postprandial because I felt I would go low if left with eating nothing.

How do you guys basal test? In the book it says to test when it has been 5hrs since your last bolus and at least 3 hrs since your last meal. This makes no sense to me since I would never eat a meal and not bolus. My BG would go through the roof!! How long do you wait to start your testing after your last meal and all that?

Thanks so much and sorry for the long post

[CrazyGramma]

Hi T1snce5yo

I am currently doing a complete overhaul which includes basal testing. Search the other threads for "basal test" as there have been a lot of resouces on how to do this circulating. I can forward but I am at work and soon to be fired for not working - just wanted to make a quick reponse. I have cut the 24 hour day into segements. ie. midnight to 6am is the easiest as your not having a meal at that time tyically. I test every 2 hours and make adjustments according to what I see. Keep in mind there are a ton of factors that effect bgs. It is worth doing as I feel better than I have in years.

[CrazyGramma]

CrazyGramma again. Looks like this is your first post so....Welcome to the forum. Best place I've been in years. Very smart, kind and knowledgeable people are here!

[BlueSky]

... In the book it says to test when it has been 5hrs since your last bolus and at least 3 hrs since your last meal. ...
This sounds like a bit of a contradiction, because of the way it has been worded. I think they are saying that you shouldn't eat between having your last meal and starting the basal test. I suspect the 3 hours since the last meal is the time it normally takes for the stomach to empty, and you don't want to test before this has happened. The 5 hours since the last bolus is the time it takes or fast acting insulin to finish it's job. When you start basal testing, you want to be sure that only basal insulin is active in your body.

Welcome to the forums. And good luck with the basal test.

[Gary_W]

Hello and welcome :)

The 3 hours since eating thing can be this; you may have had a high BG and bolused then waited an hour or two before eating.... However, when you've had raging highs or lows is not the time to start a basal test IMO.

If your overnight reading is dropping, that's too much basal. I found I needed around 1/6th the amount of insulin each hour between midnight and 4am. It then ramps up for DP.

The way I tested was to ensure I hadn't eaten or bolused in the runup to bed. That way, you know that no food is in your system and the only insulin doing anything is your basal. Test before bed. You want the reading to be in a 'normal' range, as if you start off too high or too low it can skew the results.

I typically go to bed around midnight. I set my alarm for 3.30am and test again. What I was looking for was the 3.30am number to be the same as the bedtime number. It took several nights of taking the basal back until it worked out. At that point, you know that any rise or fall you see in you morning number is due to the 3.30 to dawn basal and you can then adjust that up or down as appropriate.

Obviously if you feel unsafe due to lows coming on you can test more often. For the first few nights on my pump I tested every couple of hours.

Once your morning BG is the same as your bedtime one (or as close as you feel is needed) then move on to the next one. This is trickier as it involves missing breakfast. You'll start with your nice waking BG as you've already sorted out your overnight. Miss breakfast, don't inject. I don't even drink tea or coffee (water only). I tend to test every 1/2 hour, but that's probably overkill...

As for 'which basal segments to adjust and how much?'. Well, there are far more experienced pumpers here than I am to answer that bit. I'm winging it at the moment and (mostly) doing OK, though I do seem to be having a few lows mid to late afternoon so I need to try and sort that one out.

Gary

[CrazyGramma]

I started basal testing with the midnight to 6am, then did 6am to 11am to manage the DP and then moved to evening in shorter segments because my carb ratio is way off and don't want to try and figure that out at the same time. I'm not in a rush as I have had mediocre control for years. There is something quite uplifting about during a 5 hour fast seeing bgs flat with very little rise or fall.

[xMenace]

Welcome,

Basal testing isolates basal insulin action. That means you want NO food and NO bolus action happening.

Learn about how to do it and be comfortable with making adjustments BEFORE undertaking a test. Do it carefully and systematically. Do it right, get it right, and that control will definately tighten up.


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

Getting Down to Basals :: Diabetes Self-Management (http://www.diabetesselfmanagement.com/articles/Insulin/Getting_Down_to_Basals)

HOWTO profile your Basal Rates. (http://www.insulin-pumpers.org/howto/baslr.html)

PDF Worksheet (http://www.centremedsurg.com/Forms/Basal%20Rate%20Worksheets.pdf)

Humalog profile - for adjustments (http://www.diabetesnet.com/diabetes_technology/dia.php)

Advanced pump techniques (http://www.childrenwithdiabetes.com/presentations/AdvancedPumpManagement200603.ppt)