The whole idea of basal testing is to identify the basal-rate profile that will keep your BGs flat if fasting. If you have dawn phenomena, it will be revealed when you do the overnight basal test by an increased need for basal insulin in the dawn hours to counteract a tendency for your BG to rise during this time.
I could be wrong, but I think that people who report a rising morning BG when they don't eat breakfast at a normal time, are simply observing a basal rate that is too low for their morning basal needs. When the morning basal rates are ideal, the morning BG should remain flat when breakfast is delayed or missed. I speculate that these people are simply "borrowing" some of their usual breakfast insulin dose to help control their basal need. If they delay or cancel breakfast, their BG rises. There's nothing wrong with borrowing bolus insulin to compensate for an inadequate basal rate. As long as you get the insulin you need at the time you need it, everything's cool. It makes good analysis, however, difficult when something goes wrong.
Your temp basal rate of -10% (90% of your normal basal rate) suggests that your current basal rates are set too high. With basal rates, timing is everything. In addition to the correct basal rate, you'll also need to discover when to change to a lower or higher rate. This will determine how many "time blocks" you personally need in your 24-hour day.
AR - Do you use multiple basal profiles to manage workday vs. weekend? It seems that it might work in the situation you describe. I only use one basal profile.
That's true! I usually just work around one profile, turn rate up 200% or whatever to "clean up" a mess and then it settles into place once I'm past DP and EP (exercise phenomenon, LOL...) to get back to normal. A lot of times, if I wake up, I just wake up but this odd, long holiday season this year was perhaps sort of out of whack too. I would rather have one setting I know how to use and just modify it as needed I think.
Yeah, the roller coaster thing really sucks, but once you get your basal rate set things get a lot easier, and then you can tweak your boluses. Don't worry, you will get there. Also, while you don't have insurance in India, maybe your insulin is cheaper. Without insurance, few in the US can afford the better insulins. Finally, many of us use needles (on MDI, multiple daily injections). My BG is pretty well managed with 2 shots of Levemir (long acting insulin) for basal and shots of fast acting Apidra as needed for bolus. With MDI, I've found that any failure in my BG management is mostly the result of my diet and failure to bolus early enough for the amount of carbs I am taking in.
I think I'd focus right now on getting your basal close. Then once you are off the roller coaster, you can worry about tweaking it. What works for me is simply not eating for 6-7 hours, and then periodically testing to see what direction my BG is heading. Do that a few times at different times of day, and you'll have some idea if your basal is too high or too low. Adjust it as needed. You need to take control of how much insulin to take. Then once you have basal figured out, you can figure out your bolus/correction ratios.
Another key for me is taking control of what you are eating. If you eat a lot of food/carbs and don't have a good idea of how many carbs then your bolus is probably going to be way off and result in a high or a low. Again, lowering the simple carb intake simplifies the game. If I eat 50-60g of carbs in a meal, I have to time the insulin almost perfectly to avoid a high or low. If I eat 10g of carbs in a meal, correcting for it is very easy. Okay, my meal might be high in protein and some slowly gets converted to carbs, but it is very slow and easy to correct for. I'm not saying to eat salad and meats/eggs all the time, but while you are figuring all of this out, it might be a good strategy in the short term. Then as you get things under control, you can start to manage the higher carb meals.
Anyway, those are my thoughts, but I'm still fairly new at this too. Keep reading/learning and asking questions here. I felt very alone before I found this place. The support and information here is tremendous.
You could be also right but I have read in Bernstein's book also where he talked about insulin tapering off and sugar rising when breakfast is delayed. It's very hard for me to wake up during sleep after every couple of hours. Here in India we eat dinner late, between 9-10pm and that delays my basal test inconvenient.
Yeah, the law of small numbers. Small inputs makes small changes and Large inputs produce large changes - Dr Bernstein. I know eating protein helps in achieving good Post Prnadial figures as my breakfast is mostly Fat n Protein food. 3 Eggs and one cup of coffee [half milk and half water] and that has always kept me from going higher after 2 hours but the protein diet may produce false results during the test.
I have to do Basal test and i dont know where to begin from.
I eat dinner late and mostly don't take bedtime reading. HOpe I do it soon.
Milk has a good amount of carbs, and protein does increase BG. It does so slowly, but around 50% of those protein carbs end up getting converted to BG.
In my case, I was using a bit too much basal to cover the carbs that resulted from the protein, and then I would periodically get lows that required me to eat more food. Also, I've found that eating late at night is a problem once you get the right basal rate. I do it too much, but I shouldn't.
SO after frequent episodes of hypo and set them on 10 percent reduced TBR I met my endo on last Friday. He didn't make any change except to make the 10 percent reduced TBR as my current basal program. I wasn't satisfied with the response and still facing the problems so decided to do it again last night. The readings are as - 1:00 AM -115 [Bedtime]
3:00 AM - 101
5:00 AM - 98
7:00 AM - 125 [Woke up]
9:00 AM - 135 [Before breakfast]
My basal rate between 12AM - 7AM was flat 0.67/hr and 7-8 AM - 0.70, 8-9 AM 0.80.
I guess I need to increase the 7AM-8AM basal rate to 0.72. Any suggestions?
Plus is it right to do the basal testing after waking up? I mean I don't want readings to be erroneous just because I didnt eat anything after waking and that caused the high reading.
Thanks.
That looks like a really brilliant day. I figure the insulin takes a while to get cooking so I try to run my basal up a smidge before my BG starts spiking. I've had some interesting days lately as I've been working out pretty hard, new stuff that seems to crank my BG up but then, once the corrections hit, I'm chasing it the other way all day too. I like htat set of numbers you're reporting though, I'd be pretty pleased with that result for me!
I'm more worried about day readings that actually spike. The readings overnight till 9AM were almost as similar as my last basal test. My dr asked me to stay on the 10 percent reduced basal and strictly told me not to touch it. And I'm kinda scared to touch the basal, but my basal isn't set right for sure.
Since 5 AM bg started increasing, I'm no sure whether I should increase the 5-7AM dose as it jumped 27 points straight or I should just forget the increase between 7-9 AM as it is still within 30 points limit from the first reading at 1AM, which is 115 or to increase the basal 0.2U/hr at 7AM to set the 9AM increase that fell off the chart.
If it starts increasing at 5AM then you want to make a slight rise in the basal at 3AM. According to John Walsh, you always make the change for the period two hours before the time with the problem. If you are finding, as many do, that you rise all morning from 5AM-9AM, then you would change it from 3-7.
Hi Zoe.
Sorry I misinterpreted above. actually bg started rising from 7 am and to counteract I wanted to increase from 5 AM but since straight from 1AM - 9 AM itw as within the 30points range if you have seen the results above i’m confused whether to take any action or not.
Ah, I see. For myself, I don't worry so much about the number of points I rise or fall as to what the actual number is and whether it is within the range I'm comfortable with.
Sorry I hadn't looked at your numbers above; they look pretty near perfect to me. A couple possibilities: If you can eat sooner after getting up that might solve the problem of the continued rise. Many people have that rise with DP and the best solution is just to go ahead and eat breakfast! Personally if I had a 135 before breakfast I would just add a small correction in with my mealtime bolus. I wouldn't worry about further changing the basal unless you see a pattern and the numbers start getting a bit higher. The problem with basal testing is it's just a onetime experience and I don't make changes until I see a pattern. I would just continue testing and logging your numbers in the morning and see what happens. But eating earlier may solve the whole problem.
This is my second basal test and in both the cases it has been proved I remain within the range till 9am, though at 9 am I see the the highest reading among the all basal readings. And this I believe is the cause of late breakfast. May be 0.2 more units at 7am solve this. But if delayed breakfast actually causes problems I’m worried about the Morning Basal Test as it can cause the erroneous readings.
To be honest, Chadha, I think you're over-thinking this. I'd love to consistently have those numbers! I would just try eating breakfast sooner and seeing what happens. I disagree with your doctor that you shouldn't change anything, but I think sometimes we over-think things and then make changes too quickly, causing uncertain results at best, roller coastering at worst. Try one small thing (I advise earlier breakfast) then watch the results for a couple days before changing something else. People who deal with DP where it just keeps rising, find that eating is a lot more effective than throwing more and more insulin at it.
From tomorrow I will be doing early breakfast anyway. So not a problem. Im more worried because my readings after breakfast till supper/dinner keep rising n that im sure because of the low basal that needs to be tested n recheckd. Doing basal tst overnight was never my target but the morning, afternoon n evening. My dr has set my basal rates for lunch n dinner high than the orginal requirement to kill the rise caused by high carb meal. 70-80 carbs. Lately, it is not working out. Today aftr lunch I fell asleep had tingling in my feet as Im a neuritis patient already n 3 houra after dinner woek up qith 193. After giving CB N bokus for tea, before dinner I ended ip with 207. My corrction factors arent woking as well and I suspect the low basal.
If it rises after you eat, it's not necessarily totally because of the low basal. I look at the the 2 hour post-meal readings (although I can "cheat" with a CGM and sort of keep an eye on the "curve"...) as where I measure bolus, not basal. The basal I look at other times, or pre-meal. Breakfast is sort of a unique case. A lot of days, it's hit or miss whether it works. Maybe I contribute to it b/c I work out in the AM a lot and will see it drifting up, correct while I'm halfway through the workout, then am ok but then it flies up and I sort of nudge it, bolus for some extra carbs that I don't eat or for something I'll eat in an hour, after I get to work, fruit or something, when the benefits of working out catch up and it starts to crash.
I agree with AR that it's important to sort out what is basal and what is bolus. It sounds like you need to tweak them both. The general thought is to fix the basal first, then once that is keeping you more or less stable during the night and in between meals (say three hours after each meal before the next) worry about I:C. I know some people have their basal in part being used to cover meals, but I wouldn't intentionally do that. Once your basal is set I would work on getting your I:C ratio right so that you end up in range two hours after eating. Some of us find that for higher carb meals, especially if they include high fat too, we need to do an extended bolus: some before the meal and some later. But frankly some of us find it near impossible to cover very high carb meals with any kind of accuracy. You might find it makes life easier by lowering your carb intake somewhat. I know Indian food is on the high carb side, and of course it's so yummy, but you might find there are some foods you just can't eat, or not on a regular basis. We all have different ones. For me, rice is nearly impossible, as is cereal. As a vegetarian I was used to eating rice, but now no longer do. I can eat pasta only occasionally and sometimes it works (with an extended bolus) and sometimes not. I eat exclusively eggs for breakfast. I would suggest playing around with different foods once you get a reliable I:C. Your I:C might also differ for meals; mine, for instance is 1:6, 1:10 and 1:17.
