Is it ok to slowly, cautiously tweak up basal rates until my pre meal BG is around 90 to 100? I understand the importance of basal “testing” according to the books, Think like pancreas, and Walsh’s book. But skipping meals during the day time (lunch and dinner) is too difficult for me. I become too hungry. Therefore, I have not tested my daytime basal.
This is what i’ve always done under the guidance of my endo and other doctors. The point is to increase rates slowly and test consistently. The thing that has really helped me is looking over my CGM graphs and my testing points from my pump. If you don’t have a CGM, then look over your numbers in a graph form you can retrieve from your pump. The point is to see where your highs are so you can increase your basals strategically and carefully. Pre meal BG 90 to 100 is usually my goal. I’ve always been told by my endo its a range I should aim for as I’ve always felt it was the right range from the all research i’ve done on my managing diabetes.
I think the other thing you also need to focus on is that your basals are your background and bolus is your foreground- basals happen through the day regardless of your boluses for meals. You need to be careful that if you eat around a certain time consistently and a basal is around the same time you don’t increase your basal too much to tie in with a tight carb ration for your bolus. Your pump is following the orders you put into it. You might unknowingly give yourself too much insulin from the carb ratio and basal setting combined. I’ve done this before which is why I am much for careful about it now.
I wish you the best,
Busybee
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You really need to skip one of your meals per day if you want to get accurate basal rates. Otherwise your bolus insulin will surely (not to mention the bg-raising action of your food) affect your numbers and then you won’t know what part your basal is playing in getting your bg’s level, sans boluses/eating. You can fast for fasting blood tests, right? So you are going to have to skip a meal if you want to know if your basals are accurate. You can do it., I think you just don’t WANT to do it.
There are two parts to my questions:
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If I eat breakfast and bolus and skip lunch, this is what I'm thinking about the test duration/coverage and please correct me if I'm wrong:
Breakfast/bolus at 7:30 AM.
Bolus insulin may be effective for as long as 5 hours (theoretically); until 12:30pm. The basal test period would be for the duration from 12:30pm to dinner time - about 5 hours.
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A dietitian once told me that if we do not eat, our blood sugar will rise because the liver will dump sugar into our system. If skipping lunch is the exception, would this lead to a higher liver sugar dump than if having lunch? ( I do not know if the dietitian is correct in what she told me.)
TIA.
BTW -I usually have food/breakfast with me for the fasting blood tests. After the blood is drawn - I eat. I do get hungry often and easily. Anyone else experience this?
- Yes, the best choice if you want to know your basal rate is to skip the meal, in this case lunch.
In your scenerio, breakfast/bolus at 7:30am, then how long do you wait to test? I usually test an hour and half after i finish eating, not 2 hours. I’m pregnant so I have to test an hour to an hour and half. Whenever you test, if you are high after the meal, you need to determine if its due to overeating, the meal, or your carb ratio isn’t tight enough. So determine that first. If you are too low after you have tested then adjust your carb ratio and possibly sensitivity ratio.
I’m not sure about the 5hours duration. That seems a little long. Do you know for sure its 5hours? On my pump, under the Bolus settings, my active insulin time in 4 hours. Remember your insulin is short acting.
Anytime you have a high not from a meal bolus your body is letting you know you need insulin. And yes, the liver will release glucose into the body. This could happen fasting or not though. My doctor has always told me, it doesn’t really matter when you have a high, you need to figure out how to deal with it. So if you just ate and you have a high, its probably from a bolus issue requiring an adjustment. If you have a high and you haven’t eaten in a couple hours then its basal issue. If you ate and a basal setting is not far behind or before a meal bolus than you can always lower the basal amount slowly to see if you need to adjust your bolus instead. Do you understand what I’m saying?
As far as eating, If I can help it, i don’t skip meals. It throws my body off too much. I get very hungry if I miss a meal. If I eat every 2-2:30 hours, I usually don’t get really hungry. In between larger meals- breakfast, lunch and dinner, I have small snacks (usually 2 a day) 15-20 grams of carbs worth. When I’m not pregnant, 10-15grams worth of carbs. This is recommended guidance from dietitians.
Do you speak with your endo about this? If not your endo, what about your pump contact from the company? I totally understand wanting to do this on your own, but getting a little help from your endo or pump specialist is best.
Busybee
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i have for the most part avoided this basal testing for this very reason. i am always hungry at meal time and snack time. the thought of fasting is so abhorent to me that i have short-changed myself with regard to making proper basal settings. i pay for it. even though my A1c is 6.4, that doesn’t mean that my BGs are on a flatline, b/c it is just an average. i look at my CGM and my meter finger sticks and i document everything. i know that fasting is temporary and setting proper basals is a gift for myself that i deserve. i need to find the courage and make the commitment for myself. i deserve to be the healthiest me i can be.
@phoenixbound " You can do it., I think you just don’t WANT to do it."
Today, I realized that I probably can do it because I ate sufficient quantities of fat and when it was lunchtime, I was not famished as I often am. I think I have some meal planning/nutrition research to do. I’m possibly not eating the “proper” types of food to sustain me from meal to meal. This is a lifelong “habit”. I’ve always been hungry between meals and have always needed to snack; and then often feeling “full”.
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For me, the length of time that insulin is active varies between the rapid insulins. Humalog lasts 4.5-5, or even a little more, hours for me. Novolog a little shorter and Apidra even less. Like everything, it will be different for you.
Yes, if you don’t eat for too long, your liver may release glycogen and raise blood sugars. One thing I read recently, however, (I wish I could remember where) is that the insulin level in the blood has an impact on this release from the liver. A properly set basal rate will, therefore, prevent your BG from rising significantly due to a “liver dump.” Because of this, a fasting basal test is both justified and meaningful.
I hope that helps and wish you luck.
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OK, so last night after writing on this site about how negligent i’ve been about fasting to test my basal rates, i began after i finished dinner at 6pm. i fasted from 6pm last night, until 8am this morning. looking at my cgm, i had a flat line all through the night. it seemed perfect. a little on the low side though, and when i did my morning pre-breakfast finger stick, my BG was only 68 (even though my cgm showed 85). so i took a BG Tablet and waited for my BG to rise. then i pre-boluses for breakfast. to my great surprise, my BGs have been flat ALL day long. this is a first (w/ some exceptions, of course). i am shocked. i made no other changes. i am eager to see how my dinner/bedtime BGs go. i am planning to re-peat the nighttime fasting test again and see if i still have low BGs. if i do, i will lower my basal by.25 and repeat the test the next night if necessary.
what i have found most interesting is that my over-night BGs and basal rate seem to have had an effect on my day-time rate. i am very curious about this. does anyone know about this or had this experience as well??
would love some answers from all of you out there in Pumper’s Paradise.
That result is so healthy. I think the overnight fast had an effect I haven’t noticed in myself but maybe I will. Digestion and metabolism is so dynamic and affected by so many details that don’t get considered. Congratulations on such fantastic progress.
I’ve tested my overnight to about 1 pm basal rate, skipping breakfast and having a later lunch.
My BG ranged from a low of 85 to 116. The low/dips occurring around 3 -6 AM.
This is a 4 day graph. I apologize that the graph included two days that I did eat breakfast - therefore the BG rise around 10:30 AM.
What are some ways in which I can bring down my fasting number closer to 80? I am on MDI.