I'll let others offer guidance on basal testing. But what strikes me is that basal (ie your background) insulin needs ro be right most of the time and you've told us that your hypos are
"once every 2 weeks" - so I conclude this is not a basal problem. But I am not an expert nor medically qualified.
It seems to me that yes, fortnightly going hypo is still too frequent, but this sort of "
infrequent" happening has got to be a combination of bolus food ratios in conjunction with some other factor. I'm slightly older than yourself; I try to live a normal and active lifestyle. But my reality is that my activity can vary hugely from day to day AND that changing activity level is extremely difficult to "quantify" in the sense of applying a numerical % reduction for my overall final bolus dose.
However when I'm active, for whatever reason, my natural insulin resistance is reduced, so any bolus insulin (basal not applicable here) already on board works more efficiently. Thus bolus arrives more speedily after injecting and mops up more surplus glucose in my blood - hence taking me low and towards hypo.
I no longer run a few km daily or even weekly and I never sprint to catch a bus - so my meaning of activity is lots of long walks, gardening, "household tasks", even shopping (can be deceptively wearing!). In contrast I rarely have a day when I do almost nothing; that's not my way. [But I can wake up feeling "off" and do nothing much - or my plan for the day can completely change, just because .... Then my BG management can also be noticeably "wrong" for what is almost the reverse reason.]
If I'm confident in advance that my day is going to be active, I will reduce my food bolus at breakfast time. My quandary almost every time is getting a precise or even a rough % for that bolus reduction. This "guesswork" has got better over the last 12 months and I seem to often use a 50% reduction. I will also apply a % reduction to my calculated evening meal bolus dose. During that busy day, often in the garden, I might either skip any lunch or just have low carb snacks and without any bolus. I might also continue with reduced bolus doses on the day after and even the 2nd day after. So this gives me a mechanism, albeit pretty crude, for managing my BG and adjusting my bolus insulin on board for any one day.
I'm not nervous about "under-bolusing" because of my 50% reduction. It is far, far better to drift towards being too high than it it is too low. Just small periods of being too low can have a detrimental affect on our cognitive abilities; whereas being unnecessarily high is pretty easily corrected with a modest bolus correction and long periods at higher levels can accentuate the risks of other diabetic medical complications - but these need a great deal more time at a highish level.
At risk of sounding arrogantly over-confident I rarely go hypo and generally expect to intercept a fall by having a snack and stopping the fall then nudging my BG into a small rise with perhaps a 2nd snack. Not just because I'm making my best effort to manage with bolus adjustments BUT I try to make full and best use of my CGM. I change (raise) the threshold for low alerts to make sure I'm getting full cautionary warning ahead of starting that busy day. I know that if I've got far too much insulin on board then intercepting a BG fall EVEN WITH help from CGM alerts will be much harder in practice.
I try to make best use of all the tools available to me - certainly having a reduction of food bolus to allow for activity and letting my CGM alert me in a timely manner are 2 major tools.
There are many, 42 and still counting, factors that affect our blood glucose and these can influence me to alter my net bolus doses. I'm attaching a link to an article from Diatribe that gives considerable insight into why BG management is such a complex problem.
Adding 20 new factors, a whole new category on behavior and decisions, and research on unexpected things that impact blood sugar and diabetes
diatribe.org
Your tendency to panic sometimes, is at least implicit amidst these 42 factors - within the more generic heading of Behaviour and Decisions. Managing one's BG is simply Not Easy.
Have you come across Gary Scheiner's book "Think Like a Pancreas"? I was fairly much indoctrinated as a young adult that Knowledge Dispels Fear and "Think Like a Pancreas is, for me, a great help. My way of coping is to try and improve my understanding of what is going on, thus to find a possible explanation for why something has happened and thus to possibly prevent that from happening again. This is not always possible to achieve - in the real world; and when I have an
unforeseen or inexplicable major BG change I then have to just accept that happened, put that event behind me and move on. I fully agree with your title to this thread "Need a Better Plan" but also know that sometimes there isn't an obvious better plan and then just respond to the event as best I can is my only sensible plan. There is no perfect way of managing our D.
