Gastroparesis and basal testing

Type 1 and LADA
1

Does anyone here have experience with gastroparesis and basal testing? Since I never know when my stomach will empty, how can I get an accurate basal test? For reference purposes, I'm a LADA diabetic and I am only on bolus insulin as my pancreas still produces some insulin.

My morning FBG #'s have jumped 10-15 pts and has been consistent for 7-8 days now. I am thinking maybe I ate something that didn't digest til later. My endo said that after 12 hrs, the effects of the food should be out of my system and she wants to see if I go to bed with a good number, she wants to see if that number rises overnight, which would indicate the need for basal insulin. I told her it's not so much that my number rises as much as it doesn't come down on it's own as good as it did before.

Any suggestions?

2

Greetings. I developed LADA & progressed to Type I. I also have gastroparesis. I know that fat & protein digest much more slowly & raise my BG overnight if I eat them at bed time. Occasionally I binge on nuts at night & it stays in my system for about 24 hours. I have to "pile on" the insulin all through the next day to keep the numbers down. I would think, if you can skip dinner or eat a meal that's light in carbs, protein & fat (such as green vegetables alone) you would have an accurate morning fasting number. Also--I wonder if your evening meals may have changed over those 7 days, which might account for the increase? Or physical activity decreased? If I have a very active day (physical labor), that will lower my BG for about 24 hrs. And then there's stress--such as tax time or term papers or family problems or a cold. All those can increase my BG. It seems like a never-ending science project, where we are our own guinea pigs! Wish you the best.

3

I have gastroparesis (GP) that the doctor described as "mild, but not insignificant."

Basal rate testing for most people doesn't start until four hours have past since the last meal. The idea is to isolate the BG rise from food from the BG rise driven by the release of gylcogen from the liver. The ideal basal rate will metabolize liver sugar only. The four hour set-up period allows both the food and the last meal/bolus insulin to completely play out.

For someone with GP, it may be necessary to extend the basal testing set-up period, usually four hours, to a longer period, maybe eight hours. I know that this is hard and inconvenient, but discovering your actual basal needs will make your insulin dosing easier. I've always found extended fasting, beyond eight hours sleeping, makes it easier to control my blood glucose, not harder.

What I would do is eat a meal that you know that your GP tolerates well and then do the 4 hour set-up followed an initial fingerstick BG. I would test every half hour to monitor. What you want is a flat-line BG that does not vary by more than 30 mg/dl from the initial fingerstick. If your BG is rising more than 30 from the start then either your last meal is still digesting or your current basal rate is too small.

This is the quandry that makes basal testing with GP more difficult. At this point, I would corrrect your BG with glucose tabs or insulin (hopefully these will be minor corrections) and add four more hours to the set-up period. If, at the end of the second 4-hour set-up your BG is still rising or falling more than 30 mg/dl, then I would abort that test and try another day.

By the way, I use intermittent fasting as part of my way of eating. Since I limit the number of carbs I eat every day, currently to < 50 grams/day, I find that I don't get hunger pangs and makes fasting easier. What I do now is to limit almost all of my eating to between 11:00 a.m. and 7:00 p.m. which, in effect, produces a 16-hour fast every day. I like what it's done for my BGs.

In summary, basal testing for someone with GP may be harder. Adding a second consecutive 4-hour setup period may be what you need. As I said before, knowing your actual background insulin needs will make your insulin dosing easier and much easier to analyze. Basal testing is a pain but the benefits exceed the work.

4

I am a LADA diabetic and on bolus only right now and endo and I are trying to determine if I need basal insulin yet. I've went from 6pm to 7am (13 hrs after dinner) without food and it seems that if I eat fiber or fat, my morning numbers will rise. Now, my GP is fairly under control and I can tell when a food sits in my stomach most of the time. I'm already on a restricted diet so eliminating more foods from my dinner meal is something I want to avoid, if possible. Last night I had turkey, sweet potato casserole, carrot souffle' and creamed spinach. I did eat some roasted sunflower seeds too. That was just before 6pm. 2 hr ppl was at 136. Forgot to test at bedtime but woke up at 131. So either my GP is getting sluggish or my body is not producing enough basal insulin to keep my BG down during the night. There are also times when my morning numbers are lower (110-117) and occasionally I see numbers close to 100. I just don't get it. During the day, I cannot figure out if my Humalog has a tail that is keeping my numbers in range or if my pancreas is still producing some basal. I've done basal testing (waking up every 3 hrs) and my numbers have been fine overnight. But in the morning after 7am, I seem to get a small bump in my numbers..........which makes me think that's when some of my food is digesting..............I sorta want to go on a little basal but at the same time, I think with some of my numbers, I will end up going low.

5

LASmith2 - Your situation is complicated and is probably changing, too. You said:

But in the morning after 7am, I seem to get a small bump in my numbers.

That could be due to dawn phenomena (DP). I'm not sure if you're familiar with this, so please excuse my explanation if you are. It's a condition found in many, but not all, people and also varies to its extent. As the body is getting ready to start the day, it seems that it makes more blood glucose available during the early morning hours. It can also be described as a predictable period of early morning insulin resistance. In any case, when someone experiences DP, all other factors being held equal, their blood glucose rises.

It appears to me that you may need some background insulin but your doctor is being cautious, not a bad thing. If it were me, I'd be curious to try one or two units of long acting insulin, like Lantus or Levemir, at bedtime. Many diabetics consider a wake up BG of 131 as sub-optimal but acceptable. A healthy endocrine system, however, will normally (with some variation, of course) be around 90 in the morning.

Your GP does complicate things and the only way that you can deal with that with regard to insulin dosing is to experiment, keep good records for a while, and learn what your patterns are. If you were on a pump you could use extended bolusing (also known as square wave or combo). Without a pump and after finding out the nature of your GP, you and your doctor may want to consider using old fashioned Regular insulin for meals. Its onset and peak are delayed (compared to Humalog) and its duration is extended. This action profile, undesirable for normal digestion, is better suited to delayed digestion.

In other words, if you find that a certain meal is well controlled at 2 and 3 hours post meal but goes high at 4 and 5 hours post meal, then an experiment with Regular insulin may be justified.

Good luck as you sort this out. I noticed your profile says you were just diagnosed in 2011. Diabetes can be daunting burden but I've found that curiosity and persistence can make your life better. Running small well documented experiments will help you learn about your metabolism. Don't wait until your doctor decides to change things. Diabetes is a dynamic problem that requires many adjustments that just don't sync up satisfactorily with the ususal doctor visit schedule.