Basal test query

[gillrogers]

How do you deal with a basal test when you wake up on a 7 but by the time you get out of bed to give your mornibg basal injection and to start the test youve just jumped up 2 whole numbers. Not sure how to assess that in my findings ad to wether i need a basal rise or not. My initial thoughts is to see what happens with the rest of the day and to deal with it as a correction calculation with breakfast bolus. Am in on the right track?

 

[littlevoice359]

You may be experiencing what's called 'foot on the floor', which happens me quite often. This is where your blood sugar rises as soon as you get up and about. This is not necessarily an indication of any need to change your basal dose. Certainly, in my case, I have not made any changes to basal. I just take an extra unit of NovoRapid at breakfast and/or take longer to eat. Usually settles down by mid-morning. So, in my view, you are on the right track.

 

[Lucyr]

I wouldn’t take a correction bolus during a basal test no. I’d leave it and see how the rest of the morning goes and whether it’s stable at the 9 it increased to or not. If it is then I’d know to correct for it with bolus.

 

[rebrascora]

I inject my basal (and bolus) insulin before I get out of bed to help deal with FOTF and sometimes set my alarm for an hour before I intend to get up to inject my basal and then go back to sleep because that enables the basal to be active enough when I do get up to fully tackle my FOTF.
As Lucy says, during your basal test, I would just carry on and see what happens.

 

[gillrogers]

I wouldn’t take a correction bolus during a basal test no. I’d leave it and see how the rest of the morning goes and whether it’s stable at the 9 it increased to or not. If it is then I’d know to correct for it with bolus.

Thanks Lucy, no I wasn’t going to do that. I was just wondering if I needed to take that rise into account with the results. I know this happens but not all the time.

 

[gillrogers]

Thanks well so far so good and it did actually drop back down sharpish after so may have just been one of libres predicted calculations that didn’t quite happen.

I tend to do my basal at 7 then get up around 7.30 , breakfast 7.45. Now finding that the lyumjev is not working as well and I’m prebolusing again. May be just because it’s so cold now. DB nurses seem to think both my basal are ok and I need to raise breaky bolus quite a bit now (but that’s cos I’ve had to cave into my protrude cravings lol) and lower my lunch time bolus a tad.

I’m so glad that I’ve finally got conditions today to do. I do wonder how some people cope with doing it. I have so many people relying on me and my job is so unpredictable as far as activity is concerned. And then there’s my daughter and her dangerous coping strategies which pop up out of the blue from her mental health. But I am struggling with my hunger. But I’m determined to do it.

 

[gillrogers]

well well guess that answers a lot but confirms what I thought with what was happening. So do I lower it which will mean a bigger increase to my breakfast bolus or just lower my lunch bolus and I’ll stead need and increase in my breakfast bolus anyway. My dinner bloods I’ve already lowered. Decisions decisions lol

 

[rebrascora]

To me that looks like it held you nicely in range throughout the morning and at lunchtime you were pretty well where you started when you woke up, so from that test I would say your basal is right for the first part of the day...... But it depends what an afternoon basal test shows as to whether you might still want to adjust it if it continues to drop your levels into the afternoon..... But obviously that would be a test for another day.
What do you think the graph tells you?

 

[gillrogers]

Hi Barbera, it tells my I’m wonky! Haha yes telling me I’m ok in the morning but I’m now down 5.9 . This explains why my correction doses to get back into range after lunch where over correcting and was needing to munch on the equivalent of half a unit in carbs. Think I may need to actually drop my basal by half and raise my breakfast bolus which I’ve got to do anyway. Porridge for ya lol.

 

[rebrascora]

Haha yes telling me I’m ok in the morning but I’m now down 5.9 .

I am struggling to understand you Gill. Are you down to 5.9 which seems fine as far as I am concerned or down 5.9 mmols from your test starting point and is that from your morning reading (ie 7 in which case I am hoping you are not horribly hypo) or from the peak it got to mid morning? Also the 7 and 9 look like they were exaggerated readings that Libre subsequently corrected because the graph doesn't go through those points, so your actual reading was slightly lower anyway, which would make 5.9 even better as a lunchtime reading.
None of us get straight lines from our basal tests if that was what you were hoping to see and it is always a question of finding a best fit dose which balances over the 12 hours or 24 in the case of longer acting basals.

 

[gillrogers]

Oh sorry Barbra. I’m down to 5.9 mmol. So the difference is from my start to end reading , not what’s in the middle? I’m carrying on for now as I won’t be able to until again with the wind up to Xmas.

 

[rebrascora]

My thoughts are that if you had taken the morning dose just maybe half an hour earlier, you might have had a slightly flatter line and that most of that arch on the graph was probably caused by the Levemir trying to catch up with and overcome your FOTF, but the fact that you are back near enough to your starting reading by mid afternoon looks to me like the dose is pretty well spot on at the moment. The action of the Levemir will be starting to tail off a bit now so hopefully it shouldn't drop you too much lower, but we shall see.
I will be interested in reading what conclusion others draw from your test results as it is always good to learn from others perspective and there is no one right or wrong answer.

 

[gillrogers]

My thoughts are that if you had taken the morning dose just maybe half an hour earlier, you might have had a slightly flatter line and that most of that arch on the graph was probably caused by the Levemir trying to catch up with and overcome your FOTF, but the fact that you are back near enough to your starting reading by mid afternoon looks to me like the dose is pretty well spot on at the moment. The action of the Levemir will be starting to tail off a bit now so hopefully it shouldn't drop you too much lower, but we shall see.
I will be interested in reading what conclusion others draw from your test results as it is always good to learn from others perspective and there is no one right or wrong answer.

Ok that’s a good idea. I tend to run my basal times 7am to 7pm so I can try the 6.30 easily. So I’m going to wrap this up at 7pm and have some supper or I’ll never sleep from being so hungry.

 

[rebrascora]

You don't necessarily have to keep the two doses 12 hours apart you know....
I take my morning dose about 7am but if I need an evening dose I usually take it at bedtime which might be 11pm or even midnight. The advantage of taking the evening one later is that there is still some active in the morning to overlap with the morning dose and give me a little extra boost to tackle my FOTF. Morning time is when I am usually more insulin resistant and I usually need less on an evening, so delaying that evening dose until bedtime means I get better coverage for when I need it. I am not saying that this will work for you, but it is something else that you can experiment with. This is "advanced diabetics" and maybe you are not ready for these sort of experiments yet but I certainly would not worry about half an hour difference in your evening dose in order to keep them exactly 12 hours apart. It isn't that critical.

 

[gillrogers]

You don't necessarily have to keep the two doses 12 hours apart you know....
I take my morning dose about 7am but if I need an evening dose I usually take it at bedtime which might be 11pm or even midnight. The advantage of taking the evening one later is that there is still some active in the morning to overlap with the morning dose and give me a little extra boost to tackle my FOTF. Morning time is when I am usually more insulin resistant and I usually need less on an evening, so delaying that evening dose until bedtime means I get better coverage for when I need it. I am not saying that this will work for you, but it is something else that you can experiment with. This is "advanced diabetics" and maybe you are not ready for these sort of experiments yet but I certainly would not worry about half an hour difference in your evening dose in order to keep them exactly 12 hours apart. It isn't that critical.

I knew an hour wouldn’t matter but didn’t know that. That’s interesting mmmm I don’t always get the fotf thing . Thanks for telling me that Barbera

 

[helli]

So I’m going to wrap this up at 7pm and have some supper or I’ll never sleep from being so hungry.

Have you been fasting all day for your basal testing?
The usual advice is to only do it for 8 hours at a time. Otherwise, your body's response to the fasting (starving?) will affect your readings,

 

[gillrogers]

Have you been fasting all day for your basal testing?
The usual advice is to only do it for 8 hours at a time. Otherwise, your body's response to the fasting (starving?) will affect your readings,

Oh I see oops that will explain why I’m down to 5.1 ok , good I can have something to eat

 

[rebrascora]

I think @helli was suggesting that yur liver will start releasing glucose into your blood stream and causing your levels to rise unnaturally if you fast too long. The fact that your levels are still dropping suggests that either it doesn't feel the need to do so OR it is releasing glucose but the basal insulin is dealing with it suggesting that the basal dose might be too much if the liver wasn't contributing more glucose. Ultimately the basal insulin is there to deal with your normal liver output, but if you create a situation where you have fasted too long, then the liver will sometimes throw out more.
Pleased you are having something to eat now.
I would say on the whole, getting to 5.1 now probably indicates your morning basal is about right as it has only dropped 0.7 this afternoon and kept your levels very nicely in range all day. I would be very happy with that.

 

[gillrogers]

I think @helli was suggesting that yur liver will start releasing glucose into your blood stream and causing your levels to rise unnaturally if you fast too long. The fact that your levels are still dropping suggests that either it doesn't feel the need to do so OR it is releasing glucose but the basal insulin is dealing with it suggesting that the basal dose might be too much if the liver wasn't contributing more glucose. Ultimately the basal insulin is there to deal with your normal liver output, but if you create a situation where you have fasted too long, then the liver will sometimes throw out more.
Pleased you are having something to eat now.
I would say on the whole, getting to 5.1 now probably indicates your morning basal is about right as it has only dropped 0.7 this afternoon and kept your levels very nicely in range all day. I would be very happy with that.

Thanks Barbera, yes i can see now so that makes sense. So i need to up by breakfast bolus ratio , lunch i think need to be reduced by half but ill sort that one after ive got my breakfast bolus sorted as that is out by about a unit .

Thank you everyone for guiding me through this.