RE: John Walsh's Pumping Insulin:Basal Testing SOS

so to continue my thread from 2 days ago, i began reading walsh’s book on finding your effective basal rates. i mentioned that after the second fasting night (from 6pm till 8am the following morning),
BGs seemed okay. stable, but on the low side. not to worry, i thought. so i continued moving along on the second and the third phase of testing. i fasted for breakfast from the night before until a late lunch the following day. a nightmare. as i fasted, i chewed on G tabs and lowered my basals to try and bring my BG up. finally i brought my BGs up into the 70s, bolused and ate a light lunch. BGs stayed stable until about 3 in the afternoon, when they started sliding down into the 60s. more glucose tabs and a decrease in my basal rates again (going back the recommended 2 hours per rate change). anyway, all of this wiped me out and frustrated me to no end. i ate a light dinner, didn’t change my basal rates anymore. thought i would just let it ride through the night until tomorrow, and if i have to make corrections i will. i cannot fathom doing another fast to test my late afternoon/dinner time basals.

For any of you who have done this basal rate testing, do you have any suggestions or solutions you could share with me? i know i will call my endo and inquire, but i would love to hear from your experiences, as i find it most helpful and informative. as i write this my BG is 119 just an hour after eating supper. i am hoping that i am stabilized, at least for the night.

so, please SOS. all suggestions welcome.

Are you a pumper? You can sete different basal rtates for different times of day - based on consistent decreases/increases at that specific time of day. It may take a few more dyas of , e.g. day basal tests, but that is one of the great things about pumping - the flexibility.

I’m really not sure I understand your post well enough to suggest anything specific.

What I think you are saying is that your current basal settings are not correct during at least some part of the day. Yes? No? Maybe? If your basal settings were correct then you should not be seeing a drop in your BG when you fast unless some other factor, such as exercise, complicates the matter.

If your basals are wrong, then it is also likely your other settings for your carb ratio and/or your Insulin Sensitivity Factor could be wrong. If the basal rate is too high then it can skew the results for the other food and/or correction bolus too low because the basal is actually providing part of the bolus insulin.

If you aren’t ready to test your basals again right now, that is understandable. But until you eventually dig into them you won’t have as firm a foundation for using your pump as I think you would like to have.

yes, i am a pumper. i have been on the pump for 14+ years. my problem is that i always relied upon my endo for basal changes and never really knew how to care for myself in this regard. my A1c is 6.4 and i thought that that meant i was doing really well. but, i know that the A1c is just a 3 month average and not the most accurate way to measure your day to day BGs. this year, i started using a dexcom cgm. i was shocked to notice the changes in my BGs and my trends. i found TuD and from all the readings i did, i kept hearing about Walsh’s Pumping Insulin book and how great it was. i was a little lazy to go out and purchase it, but finally, i ordered it on line and once i began reading it, the self-education changed my mind about helping myself. so, for this past week, i began the fasting needed to find out my basal rates. it was a horror show for me. so many low BGs. so i kept decreasing my basal rates. i am still experimenting, but today i am taking the day off of fasting and just eating my regular meals. i am eating the same thing i eat every day for consistency. i woke up with a fasting BG of 86, ate breakfast, and 2 1/2 hours later, my BG was 119. lunch is coming up, so i will test again before lunch and test again after.

thanks for your input.

John, thanks for your response. all i am trying to do is get the most accurate basal rates as possible. since having all of the BG lows, i have been continuously lowering my basal rates almost as frequently as every 2 hours. from looking at my cgm for last night my BGs were completely flat before going to bed, i set my cgm alarms at 90 to 160 (as Walsh suggests) and had no highs or lows during the night. i woke up w/ a fasting BG of 86, bolused for breakfast and all went well.

i think i am almost there, but i am taking the day off of fasting. i am whipped and need a break. but i will continue to pursue the testing after the w/end. after i get these basal rates accurate, i will go forth and work on my carb ratios (which for the past 14 years has been 1:10 u/hr. then i will attack the Insulin Sensitivity Factor. i’ll do this with the help of my endo and cde and, perhaps, Medtronic. one thing i must say is that my dexcom is a treasure. i’ve been experiencing a true education.

Good job! I am so grateful that when I first started pumping about 10-12 years ago, my CDE/trainer taught me about self-managing. She was type 1 herself, and said she wasn’t about to wait three months for an Endo to make a quick decision (or do nothing)

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thanks for that encouragement. i am watching my lunch trend now and i see from my cgm that i have to up my lunchtime basal rate and start it about an hour earlier. micro decisions. one at a time. :smile:

I have nothing like that sort of long-term experience (pumping only 1 year so far), but the CDE that Asante sent to train for for the original 30-day trial period (who also happened to formerly work for my endo!) walked me thru making all the adjustments I might need and followed up with me for the first several weeks of pumping. She also recommended that I pick up Walsh’s book (which I had done already :wink:).

John, i have a question. i did my overnight fasting 3 nights in a row. flat line throughout the night and same at breakfast. however,after breakfast my BGs went up w/in 1 hour from 111 to 170 . when i did my basal testing, this much of a rise did not happen. so i tried to micro manage w/ a correction bolus of .5 while i still had IOB to try and short cut the rise. well, w/in 1/2 hour, my BGs came down to 130. and now, w/in another 1/2 hour, my BGs came down to 93 w/ a downward direction arrow. in your opinion, should i have just let my 170 BG go w/out the correction? and, do you think this is a sign of I:C ratio and not a fasting issue?

would love your opinion.

You didn’t ask for my opinion - but that’s never stopped me before…

What did you eat for breakfast? To me, it looks like you might need bolus a little sooner before that meal in order to soften the spike. Since your BG came down and, based on the results of your correction, may have come down anyway, just later, it seems that the right amount of insulin was taken, just the timing was off. My thoughts: eat fewer carbs, change the meal (more fat or protein to slow the digestion a bit, or protein/fat first, then carbs), or bolus sooner.

i think you are 100% right. i should have pre-boluses longer. i always eat eggs for breakfast, so i know that it was not some kind of carb-over-load. i usually wait about 10 minutes w/ my pre-bolus. i waited longer for lunch and didn’t have a similar problem. in fact, i am lowering my lunch basal by .25 as i keep slipping 2 hours after my meal. i’ll keep you posted, and, i appreciate your opinion even if i didn’t ask for it. :wink:

Thas, just curious: i have read the chapter (Pumping Insulin) about fasting to determine your basal rates. but i cannot find the “fasting directions” for evening (dinner time) basal rate testing. i wanted to do this test tonight. i haven’t eaten since lunchtime and my last bolus was 10 minutes before 12pm. should i just continue to fast and eat a light dinner around 8pm? what is your opinion (or anyone else’s on this topic? )

look forward to hearing back from you and all else who care to chime in. thanks a ton,

Daisy Mae

For any basal test it’s ideal for all bolus insulin from the previous meal (lunch) and any correction insulin to have played out. I use 5 hours for my duration of insulin (DIA) action.

You also want all the previous food from lunch to be completely metabolized. Unless your lunch was a high fat, high carb meal like Chinese restaurant food or pizza, digestion and metabolization is usually over after 4 hours. So for a 6 p.m. dinner-time basal test start using a 5-hour DIA, I would start the fasting period no later than 1 p.m.

Does that make sense?

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yes. it makes complete sense to me. i have not eaten or bloused anything since right before my 12noon meal. so, basically, it has been 5 1/2 hours since i have had anything in me. there is no IOB or any food in my hungry tummy. my dinner-time basal rate is set at 4pm at .45. i will try and fast for as long as possible. then before bed time, i will have some eggs and a small cup of de-caff tea.

would 8pm be a fair enough amount of time to have been fasting if i go to bed around 10pm? (that would mean that i have been fasting since 12:15pm this afternoon; which is when i finished eating my protein no-carb lunch of tunafish and a de-caff tea).

i don’t know how this works as it is not in Walsh’s book. PLEASE HELP!!!
thanks so much,
Daisy Mae

From the time you start the test till the time you eat something will cover that portion of the day for basal testing. So, if you start the test at 4 p.m. and eat again at 10 p.m. and your BG doesn’t go up or down more than 30 mg/dl, then I would consider that test successful.

The last time I did formal basal testing I used Gary Scheiner’s protocol. I found it provided enough detail and made sense.

Good luck.

okay, here’s where i get totally confused: what is considered “starting the test” ??? does it mean that, for in your example, starting the test begins when i finish my last bolus/meal, or five hours after the last bolus is out of my system…no IOB? meaning, do i start the test 5 hours after my last bolus? am i making any sense whatsoever? i am getting bonkers. for example: i eat my lunch of tuna salad at 12pm noon. i wait for all the IOB to be finished, and wait till about 5 hours have passed since my last food ingestion, then the fasting begins. is this correct?

please elaborate.

The fasting begins once you eat your last bite from your previous meal. The test, however, does not start until the usual meal-time that you’re missing. The first portion of the fast is a prerequisite for the test but the fast continues until the test ends.

Yes, I would begin the test 5 hours after your last bolus.

If you can rely on your CGM to give you reliable feedback about your BG up/down trend, then I am not sure why you are waiting a set number of minutes. If that works well for you, then fine. But speaking for myself, I can’t just a wait a fixed number of minutes. My response to insulin is just not consistent enough for that to work for me.

When I pre-bolus I look for my CGM to start trending down before I eat. Actually since it’s not uncommon for me to be out of range during the morning, I actually wait until my BG has either dropped back into or is rapidly approaching my target range before eating.

The time this takes can vary from day to day. Usually it is somewhere between 1/2 to 1 hour. But the only way I know when is the more or less right time to eat is from the feedback from my CGM. If I were to always just wait 1/2 hour then some days I’d be spiking and others I’d be correcting a hypo … or unconscious, I suppose. :open_mouth:

at what point do you decide to end the fast? this afternoon i ate my lunch and began the fast. i waited all day until 8pm before eating my next meal. i had a very lite dinner of scrambled eggs and 1/2 an avocado. i finished this meal at 8:15 pm. did i wait long enough for testing this evenings basal rate? does that make sense?

also, i went low shortly after eating and corrected w/ a GTab and since i had been trending low since after lunchtime i lowered my basal from 4pm by .25 un/hr.

also, since i have been doing these fasting periods, my BGs have been on the cusp of 70 to low 80s and i am not that comfortable at that level, so i lowered my basal rates straight across the board. now i have 3 separate basal rates for the entire 24 hour period:

12am .425
5am .40
4pm .425 with a grand total of 9.925 basal units per day.

i think that i am doing this right. but i am not completely certain. would appreciate your opinion.

There’s no right one way to do this. You just need to cover an entire 24 hour cycle with as many segments that make sense to you. For example, If a person normally ate meals at 7 am, noon, and 6 pm, you could divide the day into 11 pm to 7 am (no need to skip a meal, but do not snack in the evening), 7 am to noon (skip breakfast), noon to 6 pm (skip lunch), and 6 pm to 11 pm (skip dinner).

You could even fast for 24 hours and do it all at once but that’s not practical for most people.

When I last did this, it took me several tries to get certain periods covered. I would start the fast, get 5 hours out and my blood glucose was too high or too low and I had to abort the test. I think it took me two weeks to string together all the test segment comprising a complete 24-hour day.

You’re not trying to find the one perfect basal pattern. It doesn’t exist since our bodies’ needs change. I found, however, if I could get close, then I could tweak my rates from there without having to do the formal protocol again.

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