I was curious how often you all test your basal rates… I haven’t had to very often, but recently I’ve been having evening lows so it was suggested by my Dr that I do the series of basal tests.
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I think basal testing is useful when you are starting out, but for me, I find if I experience a change in my numbers which is a pattern, I will tweak the basal dose for the period two hours before the problem time and that usually does the trick.
I usually leave well enough alone as long as my blood sugars are satisfactory If I get unusually high's or low's then I'll review my basals & tweek if necessary. I live in AZ. and we are having higher than normal temps. Today it was 75 and sunny which is wonderful for my usual walk in the morning which is always a plus for my blood sugars.
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I generally do informal basal testing whenever something is repeatedly "off".
There's formal basal testing, which is the "don't eat for 6 hours leading up to, and not at all during and don't get any exercise and hold still and don't breathe" version (of which I am being overly dramatic, and I understand the point full well, but since nothing else I do is held to such rigorous standards I don't think its reasonable that this should be either).
I go with the much more casual "Don't eat for a few hours as is convenient and see how it plays out" version, and then make small changes as needed. Sure, its not as accurate as the other way, but its a lot easier to fit in and breaking it down into smaller chunks of time means I can stand to repeat it more often.
For years I avoided doing basal testing because it seemed so intimidating, but breaking it down into a smaller pieces and fitting in when convenient makes it way more tolerable for me and therefor easier to do and get information out of. Potentially I have meetings every Tuesday afternoon and Thursday mornings right now, so I regularly use those days to do any basal testing because I'm probably not eating anyway- might as well hold out another hour or two and see what my BG looks like.
I am glad that they are others who don’t do basal testing as much as they say to you should. I too, wait till I see a pattern of some kind. I know John Walsh says 1 basal test a week, which is kind of unrealistic, especially if you have a busy lifestyle. When my average increases or I get alot of highs I start making changes.
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I definitely ought to make adjustments every 3 months, but I often dont. Kinda depends how dramatic the shift is, sometimes it changes so dramatically that I start having problems and need to adjust right away. If I wait that long, then I might have put myself into a bad position because it takes me several weeks, at least to get the kinks worked out. Earlier this year things got quite unsafe. Should have adjusted much sooner. I regretted my laziness.
I think everyone should know HOW to test their basal. And starting off on a pump, this should be done.
But after that, just watch for patterns.
I think a lot of the basal testing mentality is a carryover from before the CGM era. With Dexcom Clarity, XDRIP, etc. these programs will show you at a glance what your 1,3,7,14,30,90 day patterns are. Super easy to see where you need a change!
I must say I do it more often than most. And there have been a few times over the years, where I just do a clean sweep and start over. I find that I change things more often with CGM reports and sometimes that can mess things up. So last month I just set one basal rate for the whole day and did a few days of testing. I also find going 12 hours without eating doable. And than the frustration can set in when .6 is not enough but .7 is too much. And days later with multiple days of testing come up with .675. The disease never plays fair or by the rules and can be very frustrating when you get two days that show the same pattern and than the next two test days show something different. But I keep plugging away and hope I get it right. I am always amazed at the people who can go years without changing things.
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I think the old fashioned formal basal testing protocol is a good exercise, especailly for people new to pumping. As others have said, with paying attention to the CGM trace and using reports like the Dexcom Clarity 14-day AGP, it’s relatively easy to make rational changes to basal rates.
Diabetes control is a moving target. I think it’s ideal to be making changes to basal rates, insulin sensitivity, and insulin to carb ratios relatively frequently. I make changes at least a few times per month.
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I haven’t been doing any basal testing in the last few months. I usually make changes and still eat but if it fixes the area where I’m having a problem I leave it. I think with dexcom cgm we don’t have to be so regimented in basal testing. Since covid19 I haven’t seen my endo. He only wanted to know my 14day average and standard deviation.
This is what I do, too. I’ve been doing some all day fasts recently and I find it’s an excellent time to assess pump basal rates and make changes when the CGM trace is working well.
When you do you basal testing, do you consciously limit your physical activity? For example, do you sit at home rather than do a grocery run which is more physical than sitting at home. I know that exercise is stopped on the day to prevent your sugars from dropping later in the day.
I adjust my insulin dosage as I see needed without any basal testing - probably a few times a month. But they are just small adjustments, where things are high or low.
I don’t do housework or anything that I know will mess up with my bloodsugar. When I first started pumping they wanted me to do 1 a week. Pretty crazy, huh? I basically eat the same things. It helps to manage my sugars better. I will be so happy when Canada gets the 770/780. By the time we get it, it will will need to be updated to the 780. It is hard to believe that medtronic is finally getting on board with what people want in an insulin pump. Now all they have to do is be connected to dexcom. Then I’ll truly be happy.
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It is best to do nothing when basal testing.
But me being me, I don’t follow that statement 100% of the time and here is why.
My feeling is if every work day, I walk to and from work at pretty much the same time, I should do that if basal testing, otherwise I would have to make adjustments every morning and evening when I walk to and from. I do work like I normally do when basal testing my work day rates because I need it to be right on for my work days.
It is recommended to not exercise, eat, work, stress during a basal testing but it can be hard to get that period of time with nothing happening. Life doesn’t always cooperate. And than the fun part is, you need to have a couple of runs doing this. Using just one day isn’t a good idea because life happens.
I have John Walsh’s books Using Insulin and Pumping Insulin to review if I come up with weird issues.
Yes I do have a diabetes library and still after 50 years, pull those books off the shelf.
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All day fasts must be pretty hard to do. I can’t imagine going a whole day without eating.
@Dee_Meloche - Before I started eating a carb-limited diet, it did take some willpower to fast more than a delayed breakfast for a lab blood-draw. My metabolism now can easily switch between glucose and fat for energy. It takes only limited effort for me to fast for 24 hours. Plus, I am not a purist and do add an ounce or two of heavy cream to my coffee, even on fast days.
While I am not over-weight, I do have an extra 10 pounds or so of excess fat I can burn for energy. Most people who fast report that it’s easier than at first thought.
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I did my first complex basal testing about 15 years ago, and test it about every 4-5 years. Here’s how I did mine (WARNING! Im an engineer by trade and dont tolerate variations lol):
Up front: to do this properly, it will take about 30 days. But you really only need to do it once. A CGM isnt required, but VERY helpful.
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Get a notebook to track results.
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Break up the day into three, 8 hour sections.
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Make sure when you start your 8 hour block you have NO IOB, and NO carbs on board. Make sure your BG is stable (I used 130 for my testing).
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Go about your normal day. Dont use a day where you are meeting up with the family for Thanksgiving dinner or a day you go rock climbing for 6 hours. Test BG every hour, and log in your notebook.
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If your BG rises or falls more than 25 points, testing is done for that block.
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Adjust your basal accordingly to make up for the rise or fall. Retest on a different day for this 8 hour block.
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Rinse and repeat for all 3 blocks of time until you get at LEAST 2, 8 hour blocks with <25 BG points variance (I did 3).
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VIOLA! You’ve got your basal rates!
Yeah, yeah, yeah. Its alot of work and time consuming. However, if I have a day where I miss a meal, or those times my when I test again, by basals are FLAT with a variance of <25 points. Its really the only way to do it.
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