Need basal testing encouragement and advice

Type 1 and LADA
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I am an occasional lurker on these forums but not new to diabetes. My 14 year old son has has diabetes for 14 years (dxd at 9 months) and he’s been pumping for 10.5 years. I was dx’d with LADA/Type 1 8 years ago and I just started pumping in September. I had a horrible endo who provided no pump support, so I have found a fantastic new practice and my dr really wants me to do official basal testing. It is not turning out to be an easy thing. I was able to test overnight successfully and repeat the test with similar results so I know my 12am-6am rates are set fine.

Now I’m testing the evening: 5pm-11pm and I am stuck. I’ve failed the test 3 times, and I’m currently trying again today. My endo has been great and we are adjusting my rates accordingly. I am just discouraged. My lunch was at noon today – I’m eating a little more than normal, so I end up feeling really full for a while. The test will start at 5pm, when I’m hungry, and the evenings are just horrible because I’m starving. I’ve failed the test 3 times because I go low (lowest was 62, so not an emergency, I’m watching it closely). And when I do eat again I am so hungry I just can’t catch the hunger and eat so much I feel sick. I’m altering my entire routine because basal testing requires little physical activity and I’m normally quite physically active all day.

Any tips for successfully doing this test and not feeling miserable for hours and hours? I have diet sprite and sugar free jello, but that does very little. I’ve spend the evenings during these tests just laying on the couch feeling hungry and fuzzy headed and unable to function. It’s really affecting my family. Today was “Oh great, mom’s doing another basal test…get out of her way tonight!”

I’ve never had my son do this kind of strict testing – he’s always growing and his rates are always changing so it would not be worth putting him through this. Especially since his A1C is in a good range.

I have learned a lot so far – I need much less basal and quite a bit more bolus than I thought – I just had my rates kind of flip flopped. Could really use some tips and advice on making it through the testing though.

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MAIN TIP for basal testing, especially for someone new to pumping, and this is IMPORTANT:

You NEED to sneak up from below the proper basal, rather than having to keep adjusting it down, otherwise you will get low, and of course, you also can’t have IOB during the testing, which MEANS that you can’t bolus within 5 hours of the testing period. If you fail to heed those rules, you will have a heck of a time and will get frustrated.

YOU MUST start with a lower-than expected basal setting, and AVOID bolusing within 5 hours. It’s all about being super conservative with the pump’s basal settings so that you run HIGHER THAN NORMAL for a while, so that you can sneak up to the proper settings, a bit at a time.

I hope you take my suggestions to heart.

A further item to consider is dont make changes based on one day’s data. Repeat using a basal you THINK is correct, another day, and see if you concur that the basal setting is working well yet again. Don’t yo-yo back and forth by putting too much emphasis on one testing period. Repeat, to be sure. It may take a few weeks to get things dialed in well.

Any period of time when basals seem wrong, you need to lead that time period by ROUGHLY 3 hours. ie, if you want to raise your bg during some period of the day or night, based solely by basals, decrease the basal starting 3 hours prior to that time frame.

If you have DP, you may need to ramp up the basals quite a lot beginning at some point in the early morning hours.

Keep records of all the changes.

Go easy on the carbs so that you don’t bolus too much or your basal testing is going to drag on day after day.

Good luck! You’ll get it and when you do it will make for a less stressful life-with-diabetes.

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@phoenixbound all good suggestions.

@BrendaK also keep in mind that insulin is part of what stimulates your appetite, so as you get in range and away from hypos you won’t be as hungry.

I wonder about being inactive during basal testing. I would think a normal amount of activity as being okay, just not exercises. Otherwise, you run the risk of setting your basal too high when you complete the test and commence normal activities, especially if you are active.

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Absolutely a “regular” routine should be followed during basal testing.

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Thanks for the advice. I’m not sneaking up from below very well apparently. I can’t seem to start the test above 80. I’m not eating or bolusing after 12pm and the test starts at 5pm. I have to stop the test if I go below 70 so I’m just riding there, starving, for a length of time. I need to figure out how to get a higher number before I start. My dr had me cut way back at 2pm but I’m thinking it needs to be around 10am.

The test is very eye opening though. I had no idea I need so little basal and quite a bit more bolus. I had them flip flopped.

I agree with the advice to continue with normal activity. Thanks.

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Brenda - I just want to encourage you to keep up with the basal testing. I tried this many times and was unsuccessful in getting started. I was either too high or too low in the lead-up period. Three years ago I did this under the supervision of Gary Scheiner, a certified diabetes educator and author. It took me two full weeks to get through all four testing periods for a 24-hour day.

It was so worth it. From that time forward I’ve been able to make tweaks from that program. It’s a valuable thing to be able to confidently sleep through the night. I agree with the others. You should maintain your normal activity level. I walk a least a few miles each day so I would continue that level of exercise.

I would not make this a marathon effort, however. You can take a break for a few days without losing anything.

Knowing what your actual basal needs are makes setting your mealtime insulin to carb ratio easier. It’s so easy to mixup basal with bolus insulin needs. I’ll bet most people on pumps are actually using basal to cover for bolus needs or the other way around. Analysis and troubleshooting are easier if your basal rates are close to what’s really needed.

By the way, I don’t think that basal rate needs are static. You can’t just set them once and forget about them. I adjust my basal rates several times each month.

I change my basal rates two hours in advance of the expected need. It works for me.

Good luck. I think it’s worth the effort. Don’t give up!

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BTW, you most definitely haven’t FAILED - instead, you have succeeded in gaining knowledge that you didn’t have before.

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Thanks for all of the encouragement. I finally completed the evening test last night. Started at 71 at 5pm, stayed 78,78,78,84, and ended at 73. Now I have morning and afternoon to test so I’m half done. I will repeat the evening basal at some point but only when I complete the afternoon testing and can figure out how to start higher.

I’m trying to do this every other day. I need a day in between to recover!!

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I have never seen a whole lot of value in basal testing where you change your activity and sometimes even when you fast completely. My body requires a different amount of insulin in the morning when I fast compared to when I eat a small breakfast. In fact I need more insulin for the morning if I fast compared to when I eat. Similarly I walk a couple of miles after breakfast every day and my basals reflect that. If I am going to be sedentary, I use a temp increased basal. Why figure out a basal rate that won’t be correct when I go back to my daily life?

In general I can skip meals without huge BG excursions so I know that my basals are in the ballpark. I don’t believe that there is one perfect set of basals because my life is different every day, my infusion set may be new or three days old, my infusion set is in different locations, I might hike ten miles today, etc.

I have pumped for over ten years and both my endo and I are comfortable that my rates are in the ballpark. I am probably one of the most educated-about-diabetes people who has never officially basal tested.

But good luck getting things figured out. It just takes time:-)

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laddy changes in activity are what the temporary basal rate is for. I have very stable basal rates but I use the temporary rate as needed depending on what I am doing as I have a very varied schedule. One doesnt need to keep flip flopping on basal rates if they just find a basal rate that works and then adjust with the temporary rate as needed. my basal rate is comprised of five rates to manage my dawn phenomenon.

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Wanted to post an update. I finally finished ALL basal testing yesterday. I’ve successfully completed the testing for all 24 hours. 12am-6am, 6am-12pm, 12pm-6pm, 6pm-midnight. 12am-6am was correct the first try and I repeated it to confirm and make sure overnights were stable. Next it took FOUR TRIES to get 6pm-midnight down. It was just miserable and that was largely due to the fact my basals were completely wrong then and I kept going low. 6am-12pm was next and that only took 2 tries. Had a bit of dawn phenomena which my dr helped me with. 12pm-6pm was yesterday and it only took 1 try – I had already been able to see trends and make changes during the 4 tries for the evening basals so that’s why I think the afternoon was spot on already.

It took about a month of mental energy and 8 full days of testing but it’s DONE and I feel so much more confident that my rates are set correctly. My endo is not making me repeat the daytime tests to confirm, she is fine with what I’ve done. I’m not afraid to bolus for meals anymore. (Those rates changed too but they were easy to figure out.) Thanks for the encouragement!

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Yaaaay!!! You prevailed–that’s great @BrendaK–thanks for letting us know!

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Brenda – I think your experience with basal rate testing, multiple tries and some failures, is more the norm. I tried more than once to accomplish basal rate testing and gave up due to several failed attempts. Congrats on getting it done! I am impressed with your doctor, too, for persisting with this.

I last tested my basal rates three years ago, but have been able to make successful tweaks to that basic profile. I think knowing you’re in the right neighborhood is a big help. A CGM helps me, too.

Thanks for making this post. I think many here are under the mistaken belief that basal rate testing can be accomplished in few days, a week at most. That, I believe, is the exception, not the rule.

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I hate to be he bearer of bad news, but you aren’t through with basal testing. Diabetes is always evolving, so your careful study will one day be off. Mine was good for about 2 1/2 years, then problems started popping up. The saving grace is that you can probably do a good job on making adjustments. I have almost solved my morning highs, now tackling evening highs. I see mt DE about once a month, and was mentioning how my schedule has changed in the summer–walking earlier when it is cool enough and still light. She said I may have to have summer and winter basal rates…walking now 6 am and 8 pm, instead of 8 am and 4 pm. Also, since I have been on a pump for 3 years, I feel more secure making my own changes instead of waiting for someone else. The DE doesn’t care if I try my own adjustments, she just told me to change one thing at a time, and give it at least a week, that way I could tell better if it is working instaed of having a fluke day