Basal testing - a controversial view!

[Redkite]

Some of you will no doubt be shocked, but we don't bother with basal testing 😱

My son's insulin profile has been adapted over the years to find the best way to deal with post meal spikes, which for him is to front-load the insulin into the pre-meal bolus and then to have very low basals for the hours following. This successfully clamps down on the post prandial rise in BGs, without causing a sharp drop later on.

Obviously, if he were to skip a meal, the low basals on their own would be insufficient for his needs, so a fasting test would artificially show a need to increase the basal. In reality, he never skips a meal unless he is ill, in which case we would be altering his basals for the illness and getting creative with his diabetes management for the duration of that illness.

Our current clinic team are very supportive of us not basal testing, but his old hospital were very blinkered and insisted on monthly basal tests as a pointless data-gathering exercise. They were completely without value, as he would have to suspend all normal activities (swimming, gymnastics, etc.) and the results would be hopelessly unrealistic. So we refused to cooperate 😱

We just keep on top of things by frequent testing and tweaking bolus ratios or basal rates as required. I suppose I do do overnight basal tests by default as I get up a couple of times to test him. He also wears the occasional glucose sensor which can help give additional info., but I can happily say basal testing is NOT necessary!!!!

🙂

 

[Copepod]

Always interesting to hear about what's not essential / what you can get away with, in order to improve quality of life!

If regular basal tests are not essential, that gives me one more reason / removes one more objection to considering a pump.

 

[Pumper_Sue]

, but his old hospital were very blinkered and insisted on monthly basal tests as a pointless data-gathering exercise. They were completely without value, as he would have to suspend all normal activities (swimming, gymnastics, etc.) and the results would be hopelessly unrealistic. So we refused to cooperate

I'm curious to know why all activities would need to be suspended The idea of basal testing is to fit the profile for everyday living/activities 🙂

 

[Redkite]

I would think you'd have to do some basal testing when you first start on the pump, just to get a good picture of your required initial basal profile, but after that it should be whatever works best for you!

 

[Phil65]

Some of you will no doubt be shocked, but we don't bother with basal testing 😱

My son's insulin profile has been adapted over the years to find the best way to deal with post meal spikes, which for him is to front-load the insulin into the pre-meal bolus and then to have very low basals for the hours following. This successfully clamps down on the post prandial rise in BGs, without causing a sharp drop later on.

Obviously, if he were to skip a meal, the low basals on their own would be insufficient for his needs, so a fasting test would artificially show a need to increase the basal. In reality, he never skips a meal unless he is ill, in which case we would be altering his basals for the illness and getting creative with his diabetes management for the duration of that illness.

Our current clinic team are very supportive of us not basal testing, but his old hospital were very blinkered and insisted on monthly basal tests as a pointless data-gathering exercise. They were completely without value, as he would have to suspend all normal activities (swimming, gymnastics, etc.) and the results would be hopelessly unrealistic. So we refused to cooperate 😱

We just keep on top of things by frequent testing and tweaking bolus ratios or basal rates as required. I suppose I do do overnight basal tests by default as I get up a couple of times to test him. He also wears the occasional glucose sensor which can help give additional info., but I can happily say basal testing is NOT necessary!!!!

🙂

I found your post interesting and I do understand your reasoning......apart from your opinion on basal testing as unnecessary.....I agree that I too have not carried out basal testing during the day for the same reasons that you have given....after all, you will soon realise that you have basals wrong if you notice highs and lows from heavy testing.......but unless you wake and test regularly during the night...how do you know what is going on? Nighttime basal testing is easy....not that I do it often.

 

[Redkite]

I'm curious to know why all activities would need to be suspended The idea of basal testing is to fit the profile for everyday living/activities 🙂

That was the rule from our old hospital team (who were pretty useless, hence why we moved!). They wanted us to test for all 3 meals over one weekend, e.g. miss Fri tea, Sat lunch and Sun breakfast. Since he had swimming at 6.25pm for an hour on Fri's, I wouldn't have been happy anyway with him going to bed with no tea, diabetes or not! But we always ran temp basals after swimming, and our hospital forbade temp basals during a basal test. There was no logic in it basically. We have done much better by testing and tweaking, and saved the misery of having to starve the poor boy every month!

 

[Redkite]

I found your post interesting and I do understand your reasoning......apart from your opinion on basal testing as unnecessary.....I agree that I too have not carried out basal testing during the day for the same reasons that you have given....after all, you will soon realise that you have basals wrong if you notice highs and lows from heavy testing.......but unless you wake and test regularly during the night...how do you know what is going on? Nighttime basal testing is easy....not that I do it often.

Well yes, as I said, I sort of do already basal test him every night because I check at 9 or 10 when he goes to bed, then at 11/12/1am then at 3 or 4am, so we get a good picture. But I've never made him miss his tea. If we suspect problems in the first part of the night, I try giving him "easy" foods for tea for a few nights (not pasta, pizza etc) so I can see the wood for the trees.

 

[Phil65]

Well yes, as I said, I sort of do already basal test him every night because I check at 9 or 10 when he goes to bed, then at 11/12/1am then at 3 or 4am, so we get a good picture. But I've never made him miss his tea. If we suspect problems in the first part of the night, I try giving him "easy" foods for tea for a few nights (not pasta, pizza etc) so I can see the wood for the trees.

Goodness me! You must be exhausted....not to mention your poor son! testing him virtually every hour during the night......why not try a night basal test or 2? He doesn't have to go hungry....eat at 6pm and test every 2 hours through the night up to breakfast....easy and will put your mind at ease, after that, if in doubt just do a 3am test now and then?

 

[everydayupsanddowns]

I can sympathise to some extent, but the concept od systematically basal testing was *such* a massive missing piece of the puzzle for me that I'm still very keen on it.

That combined with the fact that my basal only has to be a tiny bit out for tried and trusted ratios/corrections/TBRs to completely fail to work consistently is probably all the encouragement I need.

I only do it when things seem to be 'drifting' though. I really don't see any point in basal testing for the sake of it - only ever to analyse and solve problems, which it seems like you are successfully doing in other ways. 🙂

 

[Redkite]

Oh no Phil, I didn't mean I do all those times, I'm not crazy! He does a test at his bedtime, then depending on how late he had his tea, and what type of food, and whether he did any sports after tea, I choose to test him either 11pm or 12 am or 1pm, not all three (unless he's got a vomiting bug). Then I go to bed myself and set my alarm for 3 or 4am to check him again. So it's a total of two tests during his sleep (he doesn't wake up unless I need to wake him for lucozade), and only one test during my sleep, though obviously it still means I'm chronically short of sleep. But his night levels are pretty unpredictable due to his varying activity patterns and of course growth hormones.

 

[Hanmillmum]

I'm with you on a lot of what you do Redkite. It's really difficult trying to miss meals with kids, it feels cruel. Only in the early days of pumping were we asked by our consultant to do this as we couldn't get a handle on some of the basals through the day.
Now I will try to tweak without skipping meals but if I can't get it right will eventually surrender to some proper testing (fairly rare at present with amount of snacking going on 🙄).
I feel on top of night basal testing and feel it is very much justified , it's a good 10-11 hours of sleep which is such a big chunk of 24hrs it needs to be right IMO.

 

[Lauren]

Some of you will no doubt be shocked, but we don't bother with basal testing 😱

My son's insulin profile has been adapted over the years to find the best way to deal with post meal spikes, which for him is to front-load the insulin into the pre-meal bolus and then to have very low basals for the hours following. This successfully clamps down on the post prandial rise in BGs, without causing a sharp drop later on.

Obviously, if he were to skip a meal, the low basals on their own would be insufficient for his needs, so a fasting test would artificially show a need to increase the basal. In reality, he never skips a meal unless he is ill, in which case we would be altering his basals for the illness and getting creative with his diabetes management for the duration of that illness.

Our current clinic team are very supportive of us not basal testing, but his old hospital were very blinkered and insisted on monthly basal tests as a pointless data-gathering exercise. They were completely without value, as he would have to suspend all normal activities (swimming, gymnastics, etc.) and the results would be hopelessly unrealistic. So we refused to cooperate 😱

We just keep on top of things by frequent testing and tweaking bolus ratios or basal rates as required. I suppose I do do overnight basal tests by default as I get up a couple of times to test him. He also wears the occasional glucose sensor which can help give additional info., but I can happily say basal testing is NOT necessary!!!!

🙂

I never basal tested before today, and I'm only doing it now because some of the members here have helpfully advised it (it's going well!). My old pump clinic never mentioned basal testing. It is good that you have found something that works for your son without having to basal test 🙂

 

[HOBIE]

As a kid i had to eat 4 meals a day 50g (not forse fed but close sometimes) . I used to drink 6 pints of milk a day to get the carbs into me. I addore to miss meals now & not many people understand that 😉 On the subject of 6 pints a day the only bone i have broke is a rib 😱

 

[Pumper_Sue]

As a kid i had to eat 4 meals a day 50g (not forse fed but close sometimes) . I used to drink 6 pints of milk a day to get the carbs into me. I addore to miss meals now & not many people understand that 😉 On the subject of 6 pints a day the only bone i have broke is a rib 😱

I used to have the set meals plus the two snacks, mid morning and afternoon.
Like you I'm more than happy being able to pick and choose as to whether I eat or not. To start with in a way I was afraid to not eat as I had to feed my Isophane. Now I don't worry if I don't eat all day long just as long as I remember to stay hydrated.

 

[AJLang]

The horrors of three main meals and three snacks a day😱 I don't think people realise how joyful it is being able to miss a meal or two if you want