Basal testing - is it all it's cracked up to be?

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MaryPlain

MaryPlain

Well-Known Member
Relationship to Diabetes
Type 1
I know the theory. You take away all the other variables and check that your basal rate is covering the background requirements.

However.... as I am trying to lose weight, I have drastically cut back on carbs. To give you an idea, my total daily dose of insulin has reduced from 35-40 units to 20-25 units a day. What I've noticed is that my waking levels (dawn phenomenon etc) are higher on days when I've eaten more carbs the day before (even accounting for the bedtime level).

I also notice that whenever I've adjusted my basal (normally up) in the morning, when I've gone back to eating breakfast my levels are all over the place.

Also, for basal testing you're not supposed to exercise, but I exercise every day, so just how realistic is this?

I suppose what I'm getting at is that I think that the distinction between background or basal and bolus insulin needs is not quite as clear cut as they would have us believe. My consultant always sends me forms to fill in for a proper and thorough set of basal tests before my six monthly pump review appointment, and I religiously filled these in for the first couple of times, but it seems that she only asks to see them if my HbA1c has gone up.

Any thoughts, experiences, or shared wisdom?
 
I feel similarly to you about basal testing. I understand the theory but worry that in practice it can't be all that accurate. Food and bolusing are only 2 variables in a never-ending list. I know my BG is heavily influenced by hormones so I could basal test today and all is well, but after I ovulate in a few days everything turns on its head. Also stress, tiredness, physical exertion, mental exertion, weather... And I have to say I think the higher the carb content of my diet the higher my basal needs. I don't think basal and bolus can be separated into black and white quite as easily as HCPs lead us to believe.

Having said that, basal testing has proved to me on various occasions in the past that it's a good idea. I have to confess to not doing it regularly, and I generally tend to only do so if I'm having some serious problems. But it does help to solve those serious problems. I have found that my basal is normally not too far off the mark, so I think carbs affect me quite adversely. Basal testing has helped me to identify the foods that cause the most problems and I have eliminated many of these from my diet. Basal testing occasionally also helps with my peace of mind - if I'm having a hard time, I test & it looks like my basal is okay then I feel a bit better and know that it's meals that are the problem.

I probably should basal test more often. But I hate it - I love my food, and when stressed if I don't eat I get major stomachache - and I struggle to fit it into my daily routine. Asides from that I do everything else I can to help myself, and by the book, so I try not to be too hard on myself about it.

Disclaimer(!): I must add that these are my opinions and experiences - yours may be entirely different and I am not saying I'm right not to support regular basal testing. It's just the conclusion that works best for me.
 
Basal testing is an artifical construct - BUT it's an artificial construst that frequently tells me a great deal about what is wrong with my general set-up.

Whenever things are either stubbornly high, or relentlessly low 9 times out of 10 it seems to be a basal tweak that I need - and while I can wing it for a while just bumping things up or down a notch here and there I only ever seem to get really good reliable levels back it I dig in and systematically retest my basal over a week or two.

It was exactly the same on MDI - but at least not there seems more point in running a full set of tests as I'm able to make hourly changes whenever I need them.
 
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Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day.
Tis a complete waste of time sitting on your bum all day as the result would be completely not right for your every day needs.
Same as work basals are normally different than non working days.
Hence why you have the choice of four or five basal patterns 🙂
Most know that if you go low carb this affects basal insulin needs.
So if you are chopping and changing your eating habits then different results can be expected. 🙂
 
Pumper_Sue said:
Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day...
Click to expand...

Interestingly I avoid basal testing on gym days (usually about 3 days a week), but changes to 'regular' days are reflected in the TBR/bolus reduction I guess.

It usually takes over a week of no gym visits (over a holiday period for example when gym visits usually fall away) for the lack of activity to really start kicking in for me.
 
Thanks to all for your replies, very interesting and not quite what I was expecting - thanks again.

Pumper_Sue said:
Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day.
Tis a complete waste of time sitting on your bum all day as the result would be completely not right for your every day needs.
Same as work basals are normally different than non working days.
Hence why you have the choice of four or five basal patterns 🙂
Most know that if you go low carb this affects basal insulin needs.
So if you are chopping and changing your eating habits then different results can be expected. 🙂
Click to expand...

Hi Sue - interesting - your advice sounds like common sense but goes against everything I've read and been told about basal testing re exercise.

I'm a bit puzzled by this "Most know that if you go low carb this affects basal insulin needs" - this was news to me, and I'm not sure I'd describe my diet as "low carb" although it's certainly "lower carb" than it was! As I said, my total daily dose is between 20 and 25 units (with the occasional one below 20) but only 11 of those are basal so since my carb ratio is 1:10 that means I'm still eating between 90 and 140g carbs - would you call that low?
 
I'm inclined to agree in saying that it's not black-and-white, but that it can give you a good idea what's going on.

I'm also interested in your response, Mike, as I'm about to start a few basal test days. I ride my bike cross-country to work, so sometimes about half an hour's heavy exercise. So I was planning on basal testing on my days off, like you.

However, I might just throw caution to the wind and test any old day, because when I get to work, I'm usually sitting at a desk all day... 🙄
 
MaryPlain said:
Thanks to all for your replies, very interesting and not quite what I was expecting - thanks again.



Hi Sue - interesting - your advice sounds like common sense but goes against everything I've read and been told about basal testing re exercise.

I'm a bit puzzled by this "Most know that if you go low carb this affects basal insulin needs" - this was news to me, and I'm not sure I'd describe my diet as "low carb" although it's certainly "lower carb" than it was! As I said, my total daily dose is between 20 and 25 units (with the occasional one below 20) but only 11 of those are basal so since my carb ratio is 1:10 that means I'm still eating between 90 and 140g carbs - would you call that low?
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Hi Mary,
have a read of this http://www.diatribe.us/issues/13/learning-curve

Sorry I misunderstood your lower carb as low carb.
When people do the lc thing they tend to eat more fat which does affect the basal needs for a lot of people on insulin.
90 - 140 low no. I was imagining you doing the less than 50 🙂
 
Pumper_Sue said:
Hi Mary,
have a read of this http://www.diatribe.us/issues/13/learning-curve

Sorry I misunderstood your lower carb as low carb.
When people do the lc thing they tend to eat more fat which does affect the basal needs for a lot of people on insulin.
90 - 140 low no. I was imagining you doing the less than 50 🙂
Click to expand...

Thanks for the link. I had read it before, but on re-reading found something I'd missed before - when doing a morning basal test I can't shower either because it means I have to disconnect - the reasons against are stacking up! On the other hand since showering is something I do every day.... Do others abide by this rule?
 
I would agree that basal testing isn't quite as black and white, but it needs to be done and it's a case of choosing the best possible time to ensure that your results are as clear as possible..

When I was setting up my pump, my first series of basal testing were done on a low level exercise day, so avoided excessive or heavy housework, didn't go dashing off to town or into work... This gave me a basic basal to work from, so when I had to sort out my basal for my normal daily activities, I didn't have major lows or highs..

When I went back to work, and when I changed my job to work in kennels, I did a cheat version of basal testing... What I did was set a temp basal setting and tested every hour, by using the information from blood testing and my temp basal rates, to adjust my pump.. worked out well and avoided unwanted hypo's and highs..

I used to do a regular basal check to ensure all was fine, now I only tend to do them if I'm having a indication that they might be sliding off skew a bit...
 
Ellie Jones said:
When I went back to work, and when I changed my job to work in kennels, I did a cheat version of basal testing... What I did was set a temp basal setting and tested every hour, by using the information from blood testing and my temp basal rates, to adjust my pump.. worked out well and avoided unwanted hypo's and highs..

I used to do a regular basal check to ensure all was fine, now I only tend to do them if I'm having a indication that they might be sliding off skew a bit...
Click to expand...

This is intriguing - please can you tell us more about how your temporary basal rate testing works?
 
Well how many dribbles of basal are you going to miss in the few minutes a shower take? - you can always reconnect while you and your hair are still wet.
 
Pretty easy really...

I knew that my basal for a normal non-working day was pretty spot on, as well as my carb/insulin ratio... So I set my First attempt I turned my pump down by 40% noted down the reading it was saying for each hour, and tested bg...

Looked at the pattern, set up a new profile using the information with a tweak, used the profile the next day, and hourly BG, had to treat a couple of hypo's so the next day I did a 10% noted what it was delivering every hour and BG, looked at the data, a couple of tweaks, by the end of the week, had a good working profile going..

For the kennels, I actually had two different profiles set up, as working the main block of kennels was a lot harder going, than working the other blocks B&C blocks!
 
Too be honest with my diabetes there are so many variables I sometimes wonder myself. My HbA1c was better 10 years ago with inaccurate carb counting and no basal testing then it is now. I checked pm rates 2 days ago and drifted from 8 to 3.7- I wonder if it was a hangover effect from weekend excercise. Then yesterday after lunch I spiked a 16. Morning basal isn't too badly off
I read somewhere that increased carb consumtion and bolus insulin definately increase basal requirements and vice versa. This was from a diabetes educator on an American website.
I still keep plodding on though with it. I'm sure it provides some useful information
 
I'm doing the ultimate basal test at the moment - I've had 2 units of lantus in the past 8 weeks! 😱 Woke this morning to a 4.9 🙂
 
Doc_Brown said:
I'm inclined to agree in saying that it's not black-and-white, but that it can give you a good idea what's going on.

I'm also interested in your response, Mike, as I'm about to start a few basal test days. I ride my bike cross-country to work, so sometimes about half an hour's heavy exercise. So I was planning on basal testing on my days off, like you.

However, I might just throw caution to the wind and test any old day, because when I get to work, I'm usually sitting at a desk all day... 🙄
Click to expand...


I think the caution over 'basal testing + exercise' is the likelihood of your liver wading in and royally messing things up in a not very predictable/repeatable way in that higher levels of exertion without readily absorbable carbs/bolus insulin on board can flick the liver into 'panic' mode.

Glad to see I'm not the only one who seems to struggle to find a 'normal' day to test on! It also bears out the requirement to test the same period on more than one day to make sure you aren't just chasing your tail basal-tweaking for one-off results. Best to see that there's a repeatable pattern first. 'Course that slows the process down still further 🙄
 
trophywench said:
Well how many dribbles of basal are you going to miss in the few minutes a shower take? - you can always reconnect while you and your hair are still wet.
Click to expand...
That's an interesting question. I used to know how many bursts an hour my pump delivers, but now I can't remember. However when showering I'm probably disconnected for around 10 minutes in all (I reconnect as soon as I'm dry) which is one sixth of an hourly dose - when basal testing I would imagine that it is significant, but as I do it every day, it's probably already factored in somewhere: whether I compensate by having a slightly higher basal or whether it's covered in my breakfast bolus I don't know. I'm just going by the advice in the link not to disconnect when doing basal testing!
 
Ellie Jones said:
Pretty easy really...

I knew that my basal for a normal non-working day was pretty spot on, as well as my carb/insulin ratio... So I set my First attempt I turned my pump down by 40% noted down the reading it was saying for each hour, and tested bg...

Looked at the pattern, set up a new profile using the information with a tweak, used the profile the next day, and hourly BG, had to treat a couple of hypo's so the next day I did a 10% noted what it was delivering every hour and BG, looked at the data, a couple of tweaks, by the end of the week, had a good working profile going..

For the kennels, I actually had two different profiles set up, as working the main block of kennels was a lot harder going, than working the other blocks B&C blocks!
Click to expand...

I'm still puzzled as to why you start by reducing your basal by 40%?
 
MaryPlain said:
Aren't you pumping then?
Click to expand...

Nope. I do wonder though if I would need any basals set if I was on a pump, one would imagine not! Since diagnosis I have recovered some beta cell function and gradually reduced the lantus from 20 units to zero 🙂
 
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