Basal Testing Made Easy

Diabetic_Aspie said:
Ok,

This is really depressing. I did not realise that you have to readjust the basal rate several times a year. How often do you do it, Pumper_Sue?
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At one time it used to be every couple of weeks a tweak would be needed and a full basal test every 6 weeks.
I do have Addison's, under active thyroid and TM so obviously this does have an impact as well.
Now the TM is stable I only need to make tweaks every couple of months.
 
I readjust my basal's approximately monthly. This may, however, be to do with me being of an age where my hormones are playing havoc with my BGs much more than they ever used to. So pretty much every cycle, I have to do a bit of a tweak. I only have to do a major change every season or so though.
 
Yep - as a post menopausal person, I can say I found it a tad easier once I'd finished with all them 'ormones LOL

Tweaks not major changes in my case LOL - but yes, every 2-3 months roughly. Just keep an eye on patterns. One could do this when one kept a handwritten BG diary but in practice now I just download my meter once a week (ish) and see it in black and white - find it a lot easier to see 'patterns' doing that. If it's ALL week it drops or rises at a certain time, I just choose the time 2 hours previous and do a TBR for the next hour of whatever it warrants - and then see what that does. In theory one should always do a proper basal test for that time of day but in practice I find this usually works for me. If it doesn't - then I will do it properly!
 
While doing a basal test today I was getting perfect readings then a sudden increase of 3 mol/l in an hour which coincided with very strong hunger pangs. I have not been aware of any problems at this time of day so I wonder whether this might have been a liver dump rather than a sign that my basal insulin needs a sudden increase. Is this likely? If so how can I avoid it happening during a basal test please? Grateful for your thoughts.
 
Well do you divide your testing into 'bite sized' chunks, or do you go berserk and try to do 8 hour stretches or something?
 
I'm following the forms the consultant has given me, but thinking about it, since I have breakfast at 6:30 it was about 8 hours when I had the rise. Looking at the forms, they all have six hour blocks of testing which means I would end up not eating for 10 hours in total, and this is what they expect everyone to do. Please tell me more about how you do your bite size chunks?
 
I meant the 6 hours. So repeat the test at 'this' time a different day, starting 1 or 2 or 3 hours later?
 
I'm confused. My forms from the pump team do not require going without food for longer than 6hrs IN TOTAL. Ie: carb free breakfast at 6.30 am, nothing to eat until 12.30 whilst monitoring BGs, can have lunch at 12.30. Result: your basal between 6.30 am and 12.30 pm. Sounds like it's quite different to many others?

Radders, if you go without any food for a long time, it is my understanding that you get stressed > cortisol + adrenaline surge > glycogenolysis (aka liver dump). At least that's what medical school teaches us. Having said that, since developing DM myself, I realised that 99% of doctors (including myself) know s**t all about diabetes, and should really try to learn more from the patients...
 
Radders said:
While doing a basal test today I was getting perfect readings then a sudden increase of 3 mol/l in an hour which coincided with very strong hunger pangs. I have not been aware of any problems at this time of day so I wonder whether this might have been a liver dump rather than a sign that my basal insulin needs a sudden increase. Is this likely? If so how can I avoid it happening during a basal test please? Grateful for your thoughts.
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Also, my understanding is that if you get the basal right, you should be able to miss meals without need for a snack and not require any correction boluses without carbs. Is that correct? If so, wouldn't it mean that you need to increase your basal around the time of the surge? It seems to have sorted out the dawn phenomenon for me: through most of the night, I'm on 0.375 u/hr, but if I don't increase it up to 0.450 at around 3 am AND then up to 0.475 at 4;30, my BG goes up 3-5 mmol/L, regardless of the starting point.
 
Our forms have a period of 6 hours of fasting which starts 4 hours after the last bolus and food. I shall reduce this to two hours as Trophywench suggests by adding a snack.
Aspie every time I have mentioned my difficulties with basal testing to my consultant (I also suffer from periodic bouts of acid reflux which is also exacerbated by not eating) she tells me I can eat carb free snacks, but I have found this to be poor advice as it affects my blood sugar.
Also the surge I mentioned is, I believe, caused by not eating rather than a lack of basal insulin. As I normally tend to eat very regularly, if I were to adjust my basal to prevent the surge, then when I eat normally the surge wouldn't happen, and I'd get a hypo.
 
Radders said:
Our forms have a period of 6 hours of fasting which starts 4 hours after the last bolus and food. I shall reduce this to two hours as Trophywench suggests by adding a snack.
Aspie every time I have mentioned my difficulties with basal testing to my consultant (I also suffer from periodic bouts of acid reflux which is also exacerbated by not eating) she tells me I can eat carb free snacks, but I have found this to be poor advice as it affects my blood sugar.
Also the surge I mentioned is, I believe, caused by not eating rather than a lack of basal insulin. As I normally tend to eat very regularly, if I were to adjust my basal to prevent the surge, then when I eat normally the surge wouldn't happen, and I'd get a hypo.
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Eeeep! I don't think I would last as long as that without any food! And yes, even carb-free snacks may affect your BG: liver dump in response to eating plus gluconeogenesis (converting eg protein into glucose).

I would still increase the basal about 1-2 hrs before the surge. I was recommended an EXCELLENT Book here on the forum: Pumping Insulin by John Walsh. It walks you through setting the pump up AND managing the settings later on. Through the whole chapter on the basal rate, he hammers in this message: "...If your basal rate is too high, your glucose will fall when you skip a meal. If the basal is too low, larger carb boluses are required to cover carbs and to cover the missing basal, and when a meal is skipped the glucose climbs.

This book was an eye opener for me, and made it possible to be so much more flexible with my eating!

I had exactly the same problem and exactly the same concerns about hypoing if I set my basal rate to cover the spontaneous glucose climbs.

The trick seems to be to get your basal nice and flat without any food, THEN (and only then) you can set up an accurate bolus doses (ie, I:C ratio).

So, it sounds like your basal at the time of the rise is too LOW. And to compensate for that rise, your bolus is too big for the carbs you have.

Does it make sense?

Experienced pumpers, please do correct me if I'm wrong.
 
Thanks for your input, perhaps more background might help to explain why I feel a bit wary about increasing my basal rate for this particular surge. My basal is relatively stable at this time of day at 0.4u per hour (between 2 and 3 in the afternoon). I would normally have very little action going on from my pre-lunch bolus, having eaten a light lunch about 12:30 and with a moderate amount of carbs (typically 30g, 3 u Apidra), so I think I would have noticed if I had been having a 3 point surge in blood sugar at this time and I can't see that the bolus on board would cover this, or do you think I'm missing something?
 
Oooh - Apidra! - does it actually last 4 hours for you? - I know some people find it does all it's work by 3 hours and then nada.

I haven't got flat or flattish basal rates for more than 2 hours at a time at any time of day or night! About 9 different ones, apparently randomly applied, except they aren't, they are all scientifically placed with the aid of basal testing! LOL

I don't get up at regular times or eat at regular times since I left work. Am I ever hungry? No, I don't ever recall feeling hunger since I was a child. I'd fly the flags and ado a dance if I ever did. Pete said this afternoon, what are we having for dinner - what do you fancy? I replied well I fancy nothing at all as usual - but if you mean 'What shall we have' I'll think of something! (cos I do know I'll be the one that suffers with stupid BGs if I don't)
 
Jenny to what do you attribute your lack of appetite?
 
There are many variables in your scenario, Radders - thank you for sharing it, btw.

Eg, how long does Apidra last for you? How did you arrive at your CarbF 1:10 at lunch time? How much does your CarbF change through the day? How do you know that your basal is stable at that time of the day? What is your ISF? Etc, etc.

One possible explanation for your scenario could be that that you haven't noticed your BG climb up by 3 mmol/L at 2-3 pm because you have been covering that rise by a larger-than-needed lunch bolus dose. Which means that if you increase your basal to cover for 2-3 pm climb (which means that you have to make the actual increase 1-2 hrs before the climb), you will be able to calculate your new CarbF for lunch bolus - which is likely smaller (like 1:11, 1:12, etc). So, you would not need to worry about a hypo, and you would be able to be more flexible about what you eat and when you eat it.

I would hhighly recommend reading the book, and discussing your situation further with your consultant.
 
Radders said:
Jenny to what do you attribute your lack of appetite?
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I'm the same as Jenny in that I never feel hungry (and I regular have that conversation with my OH on food!), so I'll put in my thoughts here.
My vague recollection is that the pancreas doesnt only produce insulin but also a whole load of other hormones. Most of these are still produced in a T1, but one of them is produced by the beta cells that have been destroyed - I think it is amylin? - that is involved in some way in the whole hunger thing. So my assumption has been that I do not feel hungry because I do not produce amylin (either).
Anyone got any other thoughts?
 
I didn't even know that was what amylin did Annette!

I don't attribute it to anything - I don't pay it much attention really.

I usually counsel myself if I do question it, that if I'm not hungry I won't be encouraged to eat crap just for the sake of it - although that's nob all to do with hunger really anyway - as we all know very well ! I just don't think about it. I mean there are still some things I 'fancy' eating - for instance we are sposed to be going out in a gang to a restaurant in July and I noted they serve Tournedos Rossini on the menu - so I know already what I want! (and I didn't suggest the venue either LOL)

Mine didn't disappear instantly, I don't think, anyway - it suddenly struck me one day in the noughties - when I was having a nervous breakdown, oddly - that I hadn't felt hungry for years. It was at a time when because of that mental state, I was unable to take pleasure in anything whatsoever really so it was no great bombshell. So - I kind of assumed at the time that it would get better as the mental thing did - however - it didn't, and occasionally I can eat something and think 'that was nice!' - nothing in partic, and I am still quite discerning about food, and know what I like the taste of or not, etc. Like - I wouldn't ever choose a cheese sandwich, somehow cheese and ordinary bread are both 'claggy' in the mouth - whereas cheese on a cracker are sufficiently different in texture to make them more palatable to me. However if the choice was cheese sandwiches or go without, then I'd eat one!
 
Diabetic_Aspie said:
There are many variables in your scenario, Radders - thank you for sharing it, btw.

Eg, how long does Apidra last for you? How did you arrive at your CarbF 1:10 at lunch time? How much does your CarbF change through the day? How do you know that your basal is stable at that time of the day? What is your ISF? Etc, etc.

One possible explanation for your scenario could be that that you haven't noticed your BG climb up by 3 mmol/L at 2-3 pm because you have been covering that rise by a larger-than-needed lunch bolus dose. Which means that if you increase your basal to cover for 2-3 pm climb (which means that you have to make the actual increase 1-2 hrs before the climb), you will be able to calculate your new CarbF for lunch bolus - which is likely smaller (like 1:11, 1:12, etc). So, you would not need to worry about a hypo, and you would be able to be more flexible about what you eat and when you eat it.

I would hhighly recommend reading the book, and discussing your situation further with your consultant.
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Thank you again for taking the time to reply.

I think I have read the book you mention, a long time ago, I will dig it out again. I don't find discussions with my consultant very helpful, as I mentioned in my previous post, she did not know that protein affects blood sugar, for example, so it's difficult to have confidence in her advice.

Do you think the Apidra bolus from lunchtime 2.5 hours before could really be covering such a significant and sudden rise? I thought there would be too little active bolus remaining by then. I think it lasts about 4 hours but most of its action is in the first two, but perhaps not.

I'm not conscious of being inflexible about when I eat to be honest, as I am a creature of habit!

I tried testing again at the offending times today but just as I felt the pang of hunger and did the first test it turned out I was a bit low! I'll try again tomorrow and hopefully be able to find out whether you're right.
 
I didn't get round to eating today until around 5 pm and wanted to post a photo of my Libre screen, but I'm ashamed to say I don't know how! I tried the camera icon but ended up being asked for an album... Is that right? Please could someone explain how to do it? I'm using an iPad, if that makes any difference.
 
Radders said:
I didn't get round to eating today until around 5 pm and wanted to post a photo of my Libre screen, but I'm ashamed to say I don't know how! I tried the camera icon but ended up being asked for an album... Is that right? Please could someone explain how to do it? I'm using an iPad, if that makes any difference.
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I posted a method a while ago for PotterSusan, which I've just looked out, which might help. Obviously, you're starting by taking a photo with the camera,,not screenshotting something, so ignore that bit.
'The way I've done it on an iPad is to screen shot the picture or page I want to post ( hold down on/off button and then press button at centre bottom). Then I click 'post reply' on the forum thread, then the 'upload a file' next to it. This opens a box saying 'select file' , click that and it gives you options, one of which is 'photo library' . Click that, and it takes you to your photos and screen shots, and you can select the image you want. It attaches it, and asks you if you want a thumbnail or a full image. (I always go for full image).'
 
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