I have been having some problems with my blood sugar lately and thought that I should do some basal testing. I think having your basals set correctly is important for anyone – I feel it is the foundation for your control. For me it especially important because besides all the other whacky things that can screw up my blood sugar, adding food to the mix with gastroparesis can really make things unpredictable. I haven’t done basal testing for a few months so yesterday, I decided it was time and I should just do it. If you are landing here looking for more details about how to do basal testing, you can check out the article I wrote with details how to do basal testing here.
Both John Walsh and Gary Scheiner recommend starting with the basal test overnight because that is the most important period. They also break up theirs in 8 hour shifts. I prefer to do mine for a full 24 hours so that I know I don’t have any residual food screwing things up. Normally nights are not a problem for me, so depending on what is going on, I may or may not start the testing period at night. For this particular test, mornings and late afternoons were my problem areas so I decided that I would start the test first thing in the morning. Before going to bed Wednesday night, I put my Apidra pen out of reach so I would not just grab it and take my usual first dose of the morning without thinking.
Thursday morning, my alarm went off at 7, which is the time I take my first Levemir dose of the day. I tested my blood sugar and was 95. Off to a good start!
When I tested at 8, I was up to 112 – 17 points higher than where I started. Gary Scheiner has a 30 point plus or minus spread, so I was within that spread. In Using Insulin though, John Walsh recommends not going up by more than 15 points. Since I was only 2 points over and there is a possibility of my meter being a few points off and I have DP, I decided to keep doing the test. Before anyone says that a meter can be up to 20% off, I use the AccuChek Aviva and they perform much better than the standard 20% and I am always only a few points off when compared with an actual lab.
The morning was actually going pretty good blood sugar wise. I thought for sure that I would have to lower my morning basal a unit. So far, signs were not pointing to that happening. I had a bunch of things going on this week, so by Thursday, my energy levels were pretty zapped. Skipping my morning coffee to do basal testing didn’t help the energy levels any. Besides being tired, I wasn’t feeling great and I was freezing. Since the basal testing was going so good, I decided that it would be safe to go crawl in bed and take a nap. I tested my blood sugar one last time at 11 before crawling into bed. I saw this on my meter (sorry for the crappy picture but my camera wants fed and I am out of batteries):
Four hours after I started the test, I was one point different. I thought about setting my alarm for 12 but decided not to do that. My morning basal was good and I was tired so I felt I would benefit more from a nap than waking up to test my blood sugar. WRONG! I slept until a little after 2. Before reaching for my meter, I knew what I would see on my meter was not going to be good. I was soaked from sweating.
I really, really was not expecting that to happen. I am going to do a repeat of that test to find out exactly what time I am dropping before I change anything. If I cut back my Levemir in the morning, my mornings will run higher before they level off in the afternoon. I also want my Levemir adjusted so that if I have a situation that I can’t eat, I won’t worry about going low. This is the first time in over three years since I started doing basal testing that I ended up sitting here scratching my head over what happened.
I wonder if it’s right not to eat for so long, perhaps it’s bettere to test basal at 8 hours at a time as Walsh and Scheiner say. In real life you eat once in 8 hours.
OK, your basal doesn’t have to help your bolus, but if you stay without eating so long your liver has to release more sugar than usual to give you enough energy to move and do your things so what actually are you testing ?
A prolunged fasting changes your body behaviour.
You made me think about it … that’s only my opinion
To say this in other words: basal test should let you have a basal right to:
- do right CHO counting
- delay lunch safely
Wow Kelly I could be looking at my same exact pattern! My basal rate from 7-12 is .9 and I have to dial it down to .65 at that point to not end up at 40 like that. This had never before been my pattern and one day I started having lows in the afternoon. I really have no explanation for it after looking at all the usual suspects for increased insulin sensitivity. Like you said I would try again to confirm.
Gardian- I do my basal testing usually in 12-16 hour stretches. I have tried them in 8 hour and 24 hour stretches as well. I am sure it is different for everyone but for me my liver and muscles seem to hold on to enough glycogen I never see a depletion enough that it would effect the testing. I once lost my appetite which was not due to illness and did not eat for a good 48 hours. Everything else was normal (work etc…). and about 30 hours is when it got a bit more dicey for me. Technically basal is by definition when you do not eat so I am not quite sure what you mean by all it should accomplish is letting you delay lunch. What if I don’t want lunch at all? What if my dog gets hit by a car and I have to rush him to the vet where I sit and wait for 3 hours? Kelly also mentioned that she has gastroparesis which makes perfect sense why she would want to do it in longer than 8 hour stretches. It could potentially take her longer than 8 hours to fully digest a meal making it a gastroparesis test instead of a basal test.
About gastroparesis you are right, I agree.
But I don’t believe in “by definition” things.
By definition, basal done using levemir or lantus is not a true basal: Kelly can’t do what you do with your pump, can’t change basal rates by hour.
And even if basal as done by a pump is more like natural basal, it can’t be the same because an healthy pancreas in an healthy person changes it’s insulin erogation according to your needs, if you sleep or work or exercise, so “by definition” in nature there’s no basal actually.
We talk about basal and bolus because we need to overcome our pancreas failure, so everything as to be done to reach our quality of life, not to be compliant to theories by themself.
I just say this because I talk often with endos which forget about the actual aim of the terapy and think only about what you should do according to the average diabetics , who doesn’t exist, and abstractions which are useful to understand this world, but are not fixed rules.
Kelly, you could try to lower half unit of levemir in the morning and look if the levemir you do before sleeping at nught is right or could be increased half unit, so the following morning you have the same dose, until lunch when night-levemir is over.
But that is just the point gardian- You want to make sure that in the abscence of exercise, stress, food etc. you have your base needs set. Once you know this if something out of the ordinary happens you can adjust for that with the starting point of knowing if this event were not happening you would be stable. It allows you to be proactive in other words which is what we all are trying to do.
I think an example migh illustarate the point better. We will start by assuming I have tested my basal and know they are right. Unexpectedly I have a friend come over and ask me to go out on a walk. I know that typically when I go out walking that I need to either eat some carbs or turn down the basal. But if I did not know for sure my basal kept me stable how would I determine what to do to anticipate the change in my blood glucose due to the exercise?
I agree 100% about Doc’s in general choosing therapy based on the average diabetic. I can’t see how this relates here as Kelly is testing HER basal so it is quite specific and not targeted towards averages.
Kelly- If you confirm the above pattern is actually happening I would love to bounce ideas back and forth on WHY as I can’t seem to figure it out in my case.
Garidan, in my case, I need to do more than just delay lunch safely. I need to be able to skip meals for a full day so I am really testing what I need to test. I have a test coming up that I won’t be able to eat for. I live several hours away from where I am having it done so it won’t be scheduled until around lunch time or later. I have also had several surgeries scheduled for 1 PM and didn’t even leave the hospital till around 4.
I am confused why you don’t think Levemir or Lantus is considered basal? In the book Using Insulin, John Walsh does refer to it as basal. I agree that I can’t change the rates hourly like a pump, but I do take my Levemir in smaller doses three times a day so I am not as fixed in as someone taking a once a day Lantus shot. I also think that if more people on MDI did basal testing, they might get it to work better.
Like MossDog, I agree with you that most doctors go by the average person. I knew a long ago that doesn’t work for me. Doctors had no clue how to help with gastroparesis and they pretty much left me sitting in the corner by myself. The things I have learned I have learned here. No ever doctor suggested I do basal testing to figure out if that was even close. I doubt any doctor would ever suggest doing Levemir three times a day either – I know a couple other people that do that successfully.
I am probably going to end up lowering my morning dose by a ½ unit like you suggested. I don’t think I need to increase at night though. I have tested recently in the middle of the night to make sure I don’t have a problem in the middle of the night, but normally I wake up in the 90s.
MossDog, that is interesting that you are having the same problem! Normally I take the least amount of insulin in the evenings but it looks like the times are shifting. I need to get far enough in the basal testing to test the evenings because I am not sure if the afternoon lows are causing the evening problems or that is truly a problem. I will keep you posted with new test results.