Should I suspend basal while fasting for test ?

[Danbeck]

I need to have a fasting glucose and serum C-Peptide test done ASAP Monday morning. Its Sat evening and I cant call my Dr office to ask them and did a search here to no avail! The letter instructs to fast from midnight until I have this test! They say nothing about insulin delivery while fasting ! Should I continue basal delivery during the fasting time ? What is the common practice ? Thanks,,,,Dan

[xMenace]

NO! Do not suspend your basal for any medical procedure unless specifically told to do so by a doctor! If you suspend, you'll shoot through the roof and be miserable for the day. Non-diabetics don't shut their pancreases off, eh!

[JediSkipdogg]

NO! Do not suspend your basal for any medical procedure unless specifically told to do so by a doctor! If you suspend, you'll shoot through the roof and be miserable for the day. Non-diabetics don't shut their pancreases off, eh!

That was my first response too...however.......

He's having a fasting glucose test done. What good will a fasting glucose test be if he's giving insulin? The insulin would obviously lower his BG level to normal....or maybe the purpose would be to show how his levels are doing on his current treatment method, but being on a pump that's highly skewed in my opinion.

[xMenace]

That was my first response too...however.......

He's having a fasting glucose test done. What good will a fasting glucose test be if he's giving insulin? The insulin would obviously lower his BG level to normal....or maybe the purpose would be to show how his levels are doing on his current treatment method, but being on a pump that's highly skewed in my opinion.

*sigh*

Dumb-*** doctor? Why a fasting glucose test is beyond me.

I still wouldn't suspend. I know I wouldn't even if asked because the doctor would have a hockey stick stuck in his skull.

I can't imagine doing it.

[RobiJo]

Don't suspend. All night with no basal and I'd be reading HIGH. I've never heard of any reason why you would do this....purposefully make yourself high? Fast sure, but if your basal dose is correct you should have no problem fasting. For surgeries or something a doctor may want you higher than normal. For my vitrectomies they kept me around 150, but they didn't stop my basal, just added a bit of glucose in the IV.

[Danbeck]

Its actually Medicare requires these tests prior to approval for a replacement pump. Two years ago I had a C-Peptide and made little to no insulin. But, the test wasnt done in conjunction with a fasting glucose. So now they want both tests redone from the same serum sample. Fasting glucose and C-Peptide. Ive been pumping 6 years now in July !Im well out of warranty with MM. I did the pathway upgrade to MM Paradigm 515 3 years ago, so the current pump works well ! Its just Ive been out of warranty a long time ! Would like to upgrade to 522. Dan

[JediSkipdogg]

Does Medicare pay for the pathway upgrades? I didn't think any insurance companies paid for upgrades and I didn't think Medicare paid at all for the current model pumps. So I highly doubt you could get a 522 unless you pay out of pocket. Or maybe Medicare has changes.

As for the test, Medicare is full of ****. If you produced little to none 2 years ago you are still going to produce little to none. And a fasting glucose as I pointed out above will do absolutely nothing. Heck, in my honest opinion, for what you want it for, the pump may hurt you. The pump will make sure your basal levels stay in the normal range. Therefore when Medicare sees the normal range they will think you are cured. However, if you shut it off you run the risk of running extremely high especially shutting it off for 8-12 hours.

[Danbeck]

Thanks for your reply ! No, I had to pay for Pathway upgrade myself. I upgraded from a 508. The games we must play ! Its my understanding Medicare wont cover a 522, but I need a Medicare denial of claim to get my secondary insurance to cover it. However Medicare wont even consider the claim without these blood tests. The secondary insurance doesnt require a C-Peptide test to cover a pump! So in short I get jammed in a vain to satisify a Medicare requirement for a new pump they wont provide anyway ! At 70 years old, i dont need this ! lol

[JediSkipdogg]

Thanks for your reply ! No, I had to pay for Pathway upgrade myself. I upgraded from a 508. The games we must play ! Its my understanding Medicare wont cover a 522, but I need a Medicare denial of claim to get my secondary insurance to cover it. However Medicare wont even consider the claim without these blood tests. The secondary insurance doesnt require a C-Peptide test to cover a pump! So in short I get jammed in a vain to satisify a Medicare requirement for a new pump they wont provide anyway ! At 70 years old, i dont need this ! lol

Ok, now you make 100% sense to me. My grandmother had that a while back for some back brace type item. The funny part was her secondary insurance wouldn't cover it till Medicare denied it. Medicare wouldn't deny it till her Secondary insurance stated they would cover it. She applied for coverage at both and both denied based on not filing properly. Finally after a few months of arguing by my dad, she got it.

[fgummett]

I have a FBG every six months for my specialist and have never turned my pump off. As stated above... a healthy Pancreas does not shut off for a fasting test.

That said, I guess it depend if Medicare want to see you succeeding or failing on a Pump... if you turn the basal off and have a high FBG they may question what good the pump is doing you? I think it would be crazy for them to punish you if you have a healthy FBG with the pump working as it should.

[JediSkipdogg]

I have a FBG every six months for my specialist and have never turned my pump off. As stated above... a healthy Pancreas does not shut off for a fasting test.

True, but the purpose of a fasting glucose test is to see how well one's pancreas is doing. Heck, why aren't all Americans on pumps then? It would prevent diabetes complications tenfold.

I've never heard of a fasting glucose being ordered to determine how well one's method of giving insulin is doing. That's an expensive test that can be done at home with a $1 strip from a BG meter, not a $50 bill from a lab.

[fgummett]

I've never heard of a fasting glucose being ordered to determine how well one's method of giving insulin is doing. That's an expensive test that can be done at home with a $1 strip from a BG meter, not a $50 bill from a lab.
Seriously... do you really think that Medicare applies sense when requiring these tests, or are they just looking for a formal piece of documentation :)

[fgummett]

True, but the purpose of a fasting glucose test is to see how well one's pancreas is doing. Heck, why aren't all Americans on pumps then? It would prevent diabetes complications tenfold.
I see this test as a measure of my control... including the medication I am on. I don't stop my BP or Cholesterol pills before a test.

[JediSkipdogg]

Seriously... do you really think that Medicare applies sense when requiring these tests, or are they just looking for a formal piece of documentation :)

I agree. I guess this falls into the same category when I use to have to see my GP to get authorized to see my Endo that I had been going to for 15 years. When my parents questioned insurance they said it was to make sure I was still diabetic enough to see an Endo. Hmmmm, not sure when I was cured in those 15 years.

I see this test as a measure of my control... including the medication I am on. I don't stop my BP or Cholesterol pills before a test.

With other medication though it's to verify the medication is working. With a type 2 and pills a fasting glucose is useful. And can you really do a cholesterol test at home?

However, a type 1 (1.5 is the same) on a pump, it's a waste of money. As a type 1 on a pump one should be testing all the time and therefore that will give you the first idea how you are doing. Then you should be doing annual basal rate testing to make sure any changes need to be made. My point is a type 1 on a pump will be testing only what the BG is that one instant in time assuming their basal rates are good the previous 4 hours. Doesn'ta day have 24 hours? So how is one $50 test any proof of how well the control is?

[BlueSky]

... but the purpose of a fasting glucose test is to see how well one's pancreas is doing. ....
No, the purpose of the fasting glucose is to see how well blood glucose is being controlled. The c-peptide result reflects how well the pancreas is doing. It reveals how much insulin the beta cells are producing. And the presence of injected basal insulin won't affect the result.

[fgummett]

However, a type 1 (1.5 is the same) on a pump, it's a waste of money. As a type 1 on a pump one should be testing all the time and therefore that will give you the first idea how you are doing. Then you should be doing annual basal rate testing to make sure any changes need to be made. My point is a type 1 on a pump will be testing only what the BG is that one instant in time assuming their basal rates are good the previous 4 hours. Doesn't a day have 24 hours? So how is one $50 test any proof of how well the control is?
I agree, but point out the same logic as above.. this is Medicare we are talking about... a large bureaucratic body that runs on documentation, and as a general rule does not trust the word of the patient. For most conditions a hospital blood test is the required proof... even some doctors find it hard to conceive that someone with diabetes may be the most important member of their own health care team :D

[JediSkipdogg]

No, the purpose of the fasting glucose is to see how well blood glucose is being controlled. The c-peptide result reflects how well the pancreas is doing. It reveals how much insulin the beta cells are producing. And the presence of injected basal insulin won't affect the result.

The fasting glucose is a cheaper way of assisting to diagnose diabetes. I guess I'm not use to hearing a type 1 have a test (after their diagnosis) that can be highly skewed by their control method. So, I wake up tomorrow morning after fasting for 10 hours and run 200? Does that mean my control is bad? Should I triple my insulin level? Should I be in the hospital? No, it means I was dumb and counted carbs wrong cause the next 2 weeks I'll probably wake up at 100.

[JediSkipdogg]

I agree, but point out the same logic as above.. this is Medicare we are talking about... a large bureaucratic body that runs on documentation, and as a general rule does not trust the word of the patient. For most conditions a hospital blood test is the required proof... even some doctors find it hard to conceive that someone with diabetes may be the most important member of their own health care team :D

And then we sit here and wonder why insurance rates are skyrocketing and medicare will be drained in what, 30 years?

[fgummett]

I don't know of any large bureaucratic body where common sense figures high on the agenda :D

[BlueSky]

... I guess I'm not use to hearing a type 1 have a test (after their diagnosis) that can be highly skewed by their control method. ...
I agree, the FBG test result is not very meaningful for a T1. A much better indicator of control is the HBA1c. I suspect doctors just like to see the FBG because it is an additional piece of information.

[howdysf]

True, but the purpose of a fasting glucose test is to see how well one's pancreas is doing. Heck, why aren't all Americans on pumps then? It would prevent diabetes complications tenfold.

I've never heard of a fasting glucose being ordered to determine how well one's method of giving insulin is doing. That's an expensive test that can be done at home with a $1 strip from a BG meter, not a $50 bill from a lab.


Fasting glucose test is often given so the doc can verify your basal dosage is correct too..

I had the same question (whether t suspend basal) when I got my first A1c (post diagnosis) done.... they said DON'T suspend.

[JediSkipdogg]

Fasting glucose test is often given so the doc can verify your basal dosage is correct too..

I had the same question (whether t suspend basal) when I got my first A1c (post diagnosis) done.... they said DON'T suspend.

For an A1C that's totally different. Heck, you could drink a 2 liter of coke before an A1C and it won't affect it.

But as I pointed out above with the basal dosage, it can change so much in a day that it's pointless. My basal rate changes 6 times a day. And because one morning I wake up high doesn't mean my basal is incorrect. So one lab test of a FBG is pointless to prove anything at all for a type 1 diabetic.

[Funnygrl]

You need your c-peptide to be low for Medicare to pay.

External insulin = lower c-peptide = better chance at gaining coverage.

In other words- don't suspend.

The fasting glucose just has to be under 200 accompanying the c-peptide.

[Funnygrl]

ffective for services performed on or after December 17, 2004, in addition to meeting criterion A or B, the beneficiary with diabetes must be insulinopenic per the fasting C-peptide testing requirement or, as an alternative must be beta cell autoantibody positive. Insulinopenia is defined as a fasting C-peptide level that is less than or equal to 110 percent of the lower limit of normal of the laboratory's measurement method. For patients with renal insufficiency and a creatinine clearance (actual or calculated from age, gender, weight, and serum creatinine) «50 ml/minute, insulinopenia is defined as a fasting C-peptide level that is less than or equal to 200 percent of the lower limit of normal of the laboratory's measurement method. CMS establishes that fasting C-peptide levels will only be considered valid when a concurrently obtained fasting glucose is <225 mg/dL.

4.35 "2005 (03) March - Provider Bulletin" IBM Library Server (http://www.umd.nycpic.com/cgi-bin/bookmgr/bookmgr.exe/BOOKS/pb200503/4.35?DT=20050330100908)

So you need lower fasting bg and low fasting c-peptide- both of which will be helped by staying on pump.