I am finally going to do it, due to possible fainting causing me to fall in January and fracturing my skull and not just ice skating for the first time in decades.
While scheduling the test they insisted on me talking to the nurse about not taking my insulin before the test due to fasting, WTF. I tried to explain to the nurse that I still need my insulin and that I struggle big time with Dawn Phenomenon and will just have to see how the morning goes before I mess with my basals that morning, she insisted that I talk to my endo before the stress test.
Really? The endo will just make an across the board suggestion of lowering basals for the test, which I know from previous fasts that I will sky rocket in the a.m.
What have you done with your insulin requirements before a stress test? Would you feel the need to call the endo about insulin pump settings?
Seems to me that a stress test should be done without actually putting any stress ON you before you do it. I would just keep the basal going, and go in it like a blood draw fasting test. Don't do any bolus (I will admit that if I needed a correction for any reason I would do it). It does feel like a crap shoot, especially when we get advice that is pretty much stupid. I dunno, maybe there is a reason...I hope you will find out and let us know.
I also hope you pass your test with high marks, Karen :)
My fasting routine is to just run the basal and naturally not have a pre-meal bolus. For the stress tests, I did the same thing and then dial down the basal slightly right before the start - say 80% of normal. That was a guestimate. I checked pretty frequently (every 30 minutes )before the test and immediately after until I could get back to my regular meal schedule. Frequent testing that morning may help to tame the dawn spikes but correction boluses should be carefully managed to avoid stacking insulin.
It is always "enlightening" when health care professionals who have passing familiarity with diabetes provide guidance that is at odds with what an Endocrinologist or CDE has instructed you to do. It is tough, but in the end it can become a difficult balancing act.
I think the real answer to this question is how comfortable you feel with the exercise related to this test. A cardiac stress test has you undergo stress on your heart, typically by exercising. You will be hooked to an ECG and your heart function will be observed in the stressed state. There are variations, but that is basically it.
The key is the exercise. Typically you are put on a treadmill and they give you something called the Bruce Protocol to steadily have you exercise until your heart rate reaches a particular target. For instance, they will calculate your max heart rate as 220-age and then have you exercise to reach some percentage of that value. You can run yourself through a basic bruce protocol at home or the gym by just timing yourself through the ramping. If you are in average shape, you will likely reach the target in stages 3-5 within about 10-15 minutes.
If you have hypo problems, then you should back off your basal. But since you reach intense exercise levels within 10 minutes, you are unlikely to have a problem with lows, having highs is probably more of an issue. If you go into the test high and then attempt to do intense exercise you may just not do well. But in either case, at home practice can easily tell you how you will do.
I am still recovering from my head injury, and still struggle with walking at times, now I wonder if I should hold off on this test, but...... I want to know if I fainted because of heart issues, or because I was going low, or did I fall because of my skating. I don't remember the fall at all :(
I had that weird cardiac issue in May 2011 (arrhythmia?) and had some of those tests but it might have been cheating as I was running a lot then so I was probably used to that sort of thing, and hadn't had a head injury for maybe 12-15 months?
I would think that falling+skating would be enough but I know that sometimes they want to do exclusionary testing on people with head injury stuff going on so they can focus more? I don't recall them mentioning fasting but maybe they want your IOB cleaned out or something? Perhaps you should check w/ the doctor rx'ing the test, rather than nurses. I don't recall their being a fasting angle but maybe you're doing a slightly different test? At the end of the test, I asked the technicians if I was OK and they said "if you weren't ok, we wouldn't let you leave..." so they were keeping a close eye on me, one standing right next to me o I felt safe but passing out on a treadmill could get pretty nasty?
The ear specialist that I saw after the neurosurgeon had suggested PT for my balance issues that my PC who ordered the stress test does not know about. The ear dude fixed my dizziness, but not the pressure in my head/ear. I might give my PC a call, but I have needed this test for 8 years and keep putting it off. It is the nuclear stress test and I am having a ultrasound of my heart as well. I just know 3 months ago I could survive any exercise except for lows and now I can barely do my mile walk. Just so unsure all the time, but I guess they would stop the test if I struggled too much.
From what you're saying, I don't think that it is safe for you to do a traditional stress test on a treadmill. I had one this summer not because of any cardiac symptoms, but because I've had Type 1 so long and they wanted a baseline test.
I am in very good shape, but as I got towards the end of the test, I was actually worried about falling off the treadmill because it was going so fast. I was too stubborn to quit until I was racing along but I was kind of amazed how few safety precautions there were.
I know that sometimes they do a stress test by injecting certain drugs to make the heart rate increase rather than having the patient go on the treadmill. With your balance and neuro issues, once again I'll say that I don't think the treadmill is safe.
BTW-I took my regular insulin and my BG spent most of the morning very high (up into the 200's)from the whole mental and physical stress of the procedure. I took some conservative corrections, but did not want to take the chance of going low.
That is what will happen to me, my bgs will run high, so I am not worried about a low, but I am worried about making it through the test. Years ago the stress test was ordered because of my age and my long term diabetes, but now I wanted to know if I was fainting due to heart issues. MD's that I was seeing for my head, stated that PC should take care of any heart issues if they exist. I just feel so weak and not 100% which I know is a result of the head injury but it also could be something else that I would love to rule out. PC told me that I would be exhausted when I went back to work and man she was right. If I call PC to tell her my concerns she will tell me to wait, wonder if I could just do the ultrasound??
Karen, please let us know how this plays out for you. I've had a treadmill stress test with no fasting but my dad has the nuclear stress tests. I didn't think the nuclear test involves a treadmill portion at all? From what I understand, they give you an IV of something that stimulates your heart so that you feel like you're exercising but you're not, you're really sitting in a chair.
If a cardiologist is doing the nuclear stress test, I wouldn't think they would do the test if they didn't think it was safe for you?
The nuclear stress test injects you with a special radioactive tracer and then they perform the exercise just as in a regular stress test. When your heart is beating at max, they then take pictures and the tracer shows how your blood is flowing. The ultrasound portion of the stress test is pretty standard in both forms, they perform that when your max heart rate.
Although the treadmill I used had a railing, if you are not up to exercising in the way I described on your own, you really need to consider the drug option Lathump suggests. Many people should appropriately select to use a drug rather than exercising, my father did. Just make sure you tell your PC and the tech during the test of your condition and symptoms.
There are many different types of stress tests, including:
Treadmill stress test: As long as you can walk and have a normal ECG, this is normally the first stress test performed. You walk on a treadmill while being monitored to see how far you walk and if you develop chest pain or changes in your ECG that suggest that your heart is not getting enough blood.
Dobutamine or Adenosine Stress Test: This test is used in people who are unable to exercise. A drug is given to make the heart respond as if the person were exercising. This way the doctor can still determine how the heart responds to stress, but no exercise is required.
Stress echocardiogram: An echocardiogram (often called "echo") is a graphic outline of the heart's movement. A stress echo can accurately visualize the motion of the heart's walls and pumping action when the heart is stressed; it may reveal a lack of blood flow that isn't always apparent on other heart tests.
Nuclear stress test: This test helps to determine which parts of the heart are healthy and function normally and which are not. A small amount of radioactive substance is injected into the patient. Then the doctor uses a special camera to identify the rays emitted from the substance within the body; this produces clear pictures of the heart tissue on a monitor. These pictures are done both at rest and after exercise. Using this technique, a less than normal amount of thallium will be seen in those areas of the heart that have a decreased blood supply.
Preparation for these types of stress tests will vary from preparation for the exercise stress test. Ask your doctor about any specific instructions."
smileandnod, I have lost count of how many cardiac stress test I have down. The first was shortly after type 2 diagnosis. I called my health care providers telling them I had experienced some minor chest pains. “You come in right now!” They did a ECG which showed a right bundle branch block which I may have been born with.
Soon they had me wired up and on a treadmill which I passed with flying colors. The cardiologist said I was moderately athletic.
Since then I have done a bunch of the nuclear stress test. Contrast is injected and pictures taken, then the dreadmill getting HR up, further contrast and more pictures. The first time I had this down there was a concern that the bottom of my heart was scared, possible damage from a heart attack.
Next step was a cardiac cath which showed my heart and coronary arteries in great shape. The cardiologist surmised that my diaphragm is photo bombing my heart causing the false scaring. This has shown up on every stress test since.
I personally don’t like the treadmill because my knees are iffy. I wish they would use an cycling machine, but hey, I haven’t fallen on the dreadmill yet.
