Everyone says that a correctly set basal should put you right back where you started, even after six, seven, eight hours of fasting. Emphasis on correctly set.
I have some cardiac tests tomorrow at 1:30 p.m. – treadmill, injecting something icky with radioactiveness that we don’t want to think about, heart scan after the ickiness makes its way to my heart muscle. Gah.
So here’s the question: my instructions tell me to cut my basal insulin IN HALF the day of the test, because I have to water fast for six hours before I get on the treadmill, which we all know will be delayed because this is an HMO in America, right?
So let’s make it seven or eight hours of fasting.
I do that every night, don’t I? If I get up at my normal horrific wake-up time of 3:30 a.m. and eat some eggs and whatnot at my desk as usual at say 6:30, wiping up the last bit of egg at 6:50, that gives me seven hours until the test, say an hour on the treadmill and some being tormented in the scanner, I’m still under a “normal” fasting period for me on a weekend night (say, 10 p.m. until 10 a.m. the next morning).
I am highly skeptical that if I have a normal-sized breakfast seven hours before the test and don’t over-bolus that my basal is going to drop me into the danger zone. I’ve stayed within 20 mg/dl both times I tested it over an eight hour period of not eating and not bolusing or correcting with Novolog.
Am I being over-confident? Do you think I should cut back on my basal? They said I could have clear liquids (e.g. filtered apple juice) if my BG’s go low. Can’t I just test every now and again and not mess with being too darn high for 24 hours?
Jean - I was always told that changes in basal take a while to take effect, i.e., an overnight halving of your basal for one night might not be so immediately catastrophic on BG.
As a point of comparison - on my last holiday I stupidly packed the wrong (empty) Lantus pen. Sans Lantus, I thought I would wake up in DKA but instead found myself waking up to in the 130 range rather than my normal 80-95.
When I’ve had stress tests, I haven’t changed my basal. The only thing I can think of is that there IS an exercise component, and that can knock some insulin-sensitive people low. But if they’ll let you have apple juice, that makes the issue moot. Could be they’re practicing CYA tactics?
I think I’ll cut back by 25% just to make them happy (not 50%) and then just keep on top of it with Novolog.
I’m supposed to be water-only fasting the last three hours before the test and during the treadmill; a 25% reduction should keep me a wee bit high but not enough to make it hard too knock down with Novolog once the test is over.
Wish me luck! Nothing like knowing they’re going to put radioactive something or other in my heart to give a girl nightmares (tossing and turning all night…sigh…)
My question is who are your instructions to cut your basals in half from: are they from the cardiology team or are they from a diabetes team? If the intructions are from cardiology, then I wouldn’t bother to listen to them about cutting your basals and do what you think is right. They are likely CYA (as another mentioned) and you can do much better than that. But of course you have to plan for exercise, stress, etc.
If the instructions are from a diabetes team then I would take their advice into account. I would likely do as you have suggested and reduce basals less then they suggested. Once again I think you would know best.
How much do you cut your basal for when you’re working out when you’ve had a normal day? I had a fasting test and I had to cut it back 20% to not go low just to cover that. I have to drop my basal 20% for workouts. So when I had to do a workout with fasting I dropped it 40%. If you’re going to have a stress test it might be wise to err on the side of caution and go with their recommendations. It’s always easier to correct a little high than to have a hypo event on the treadmill and have to redo it all over again or get a bad result not because of anything but low BG.
I’ve had 2 or 3 stress tests, and they always injected through an IV in my arm. Injecting between the toes sounds HARD – finding those little tiny veins!
The radioactive stuff washes out of your body really fast. It’s a risk vs. benefit kind of thing. You get radiation just flying at high altitudes in an airplane, but you decide the risk of fast travel is worth it. For a diabetic, finding out that you have heart disease BEFORE you have a serious or fatal heart attack, when something can be done about it, seems to me to be a benefit. On the other hand, you may come out completely clear, which is what I’m hoping for!
Thanks everyone! I cut it 25% and I was at 132 mg/dl right before I got on the treadmill (seven hours water-only fasting.)
It went fine but the scan afterwards was a bit of a nightmare. Claustrophobia, panic attack (mild) and pain of 6 or so on a scale of 1 to 10 just because the “bed” of the scanner was designed by people who obviously HATE cardiology patients (grrr…)
It’s all over but the shouting and…I’m fine. Just drinking a LOT of water to tinkle out the radioactivity and eating some soup to help prevent all the water from messing with my electrolytes.
