Tweaking basal rates with or without fasting test

[SB2015]

People have mentioned in a post that they regularly tweak basal rates.

Do you always preceded this by doing a fasting test? I find that those are difficult to fit in due to busy life and regular hypos/hypers so tend not to change the basal rates as I have not done a fasting test. I find that I get into a cycle
Basal rate needs changing > Need fasting test> Can't fit that in> Can't change basal rates >
Basal rate needs changing > ...

I am trying to sort out mornings when I am regularly going high late morning so thinking it cannot be breakfast so must be basal rates. I did a basal rate test in November and they were fine then, so fiddled with CHO ratios.

I know the logic but I have tended to get a bit bogged down by it all and I am wondering whether I should just adjust the basal rates without worrying about doing a full fasting test. I also know that I have been somewhat lax about Christmas foods and sweets which I get the impressions that others are far more controlled over.

 

[trophywench]

I also know that I have been somewhat lax about Christmas foods and sweets which I get the impressions that others are afar more controlled over.

I personally apologise if you have that impression of me! Just cos I haven't mentioned it doesn't mean I don't do it. I don't tell the forum about the rough stuff unless I'm struggling and need help or encouragement to sort myself out. Usually, it's more a matter of just stopping making excuses not to do something and buckling down and just doing it with me. I've always assumed that most of us are like that to one degree or another - so why does anyone else need to know? LOL

And in answer to your actual question - yes I have done it - in fact since Xmas. Over Xmas/New Year I had a constant stream of morning hypos which could occur any time from about 6am to nearly lunchtime. I eventually knocked 0.01u off all my base rates from 04.00 to 10.00 - which has stopped them, hasn't resulted in hypers instead and hoorah - I really will have to flipping basal test now, won't I? LOL

I felt REALLY naughty doing it ! LOL

 

[SB2015]

Thanks Jenny

Tweaked last night and went the other way today so back to the drawing board.

The other possibility that occurred to me was that perhaps I am rising am because i have been low during the night and the liver dumped some glucose, but it still does not account for rise late morning, or the rise that I had yesterday from 7:00 to 9:00 of five units without having eaten anything.

I have restored previous basal rates and will now wait until tomorrow before making any other changes as I shall have a Libre sensor active and Annan check what is happening overnight.

 

[Radders]

I was running high during the holiday period, partly because I ate more carbs than usual which confirmed my theory that basal requirements are affected by the total carbs consumed and therefore the fasting basal test mechanism is not always effective. I knew that once things were back to normal my requirements would drop again so I used temporary basal rates of 120% over a few days, with some success.
I prefer to look at things holistically as I think there's more of a crossover between the basal and bolus when pumping since it's the same insulin for both. If I go high after breakfast I don't really care which insulin I tweak as long as the result sorts it out. As I can't get to work without exercising, morning basal tests are ruled out.

 

[trophywench]

Thanks Jenny

I have restored previous basal rates and will now wait until tomorrow before making any other changes as I shall have a Libre sensor active and Annan check what is happening overnight.

I was going to say - this is actually where I think I'd really find a Libre useful - but then, like, it's sort of spending money to conceal my own laziness - which of itself, just of itself seems really WRONG! Especially since, not having tried one and not having the opportunity of borrowing one even if I had to pay for sensors myself - it just seems a lot if it DIDN'T work on me.

I know I toss and turn from one side to the other all flippin night - so which arm do I stick it on, when they don't work well if you lie on them. Oh yeah stick it on the front of your arm, but sometimes I wake more or less on my front, so whichever arm is absolutely trapped under me to the extent that cutting the blood supply off to that hand, is what woke me!

 

[Robin]

.

I know I toss and turn from one side to the other all flippin night - so which arm do I stick it on, when they don't work well if you lie on them. Oh yeah stick it on the front of your arm, but sometimes I wake more or less on my front, so whichever arm is absolutely trapped under me to the extent that cutting the blood supply off to that hand, is what woke me!

This is where bingo wings come in useful. ( Not that I'm implying you necessarily have them, but the chances are at our age...) I stick mine on the flabby bit on the back of my arm, so whichever way up I'm sleeping, it sort of flops to one side and gets cushioned. I have had an occasional obvious dip and rise in the night, where it looks like I've leaned on it, but it doesn't happen very often ( not more than once a sensor, I'd say, I must sleep really oddly once in a while)

 

[everydayupsanddowns]

I went through a number of years of 'more precise' strategies where I tried to make sure I properly basal tested to inform my tweaks, but I'm afraid these days I am more likely to make ad-hoc adjustments based on the experience of those years, because (as you say SB) basal testing is a bit of a faff and actually quite hard to fit into a 'real life'. There always seems to be something coming up, or happening that makes it impractical (well... I'm just about to start being more/less active... I have a cold coming on... the weather is on the turn... so things will most likely shift after that anyway). Plus the fact that to do it 'properly' I always prefered to run each test at least twice to reduce 'one of those days' errors - so to do the full 24 hours is quite an undertaking!

These days I do still basal test as I know it is the BEST way to do it, but I don't do it every time I feel my basal needs have shifted (which can be more than once a month!). I might go for a quarterly or 6-monthly or annual 'reset' and basal test some/all/most of the day, but many of my adjustments are made in between based more on whether meals/TBRs/hypo treatments/whatever that SHOULD have worked have stopped doing so.

So I guess it would depend partly on how well you feel you know your own diabetes and what to expect it to do given reasonably consistent food/doses. eg I have more or less eaten the same breakfast and lunch choices for years with consistent ratios, so if I suddenly find I'm low at 11am or in double figures at lunch I am pretty confident that it is my basal that has shifted. If I have a period where several vhanges follow each other in the same direction, once I have shifted basal by a significant amount (keeping an eye on basal TDD) I may need to add/remove a percentage to my meal ratios. eg if my insulin sensitivity has altered with the seasons/general level of activity and I'm now needing 25% more (or less) basal my meal doses might struggle to keep up or overshoot in unadjusted. Mostly though a small basal tweak (up or down a couple of 'notches') seems to settle things again without having to tweak meal ratios/corrections.

There are times when I will 'audition' a comprehensive basal change by setting a 24 hour TBR of +/- 15-20% and then, if that seems to do the trick, I can adjust my patterns by the same amount using a phine calculator/bit of paper.

Other times it is a small change in shape of pattern and it might only be particular sections of the day that need adjusting. In which case I'd make the change in rate 1-2 hours before I want to see the change in BG.

M

Oh and PS - re Christmas indulgences... I am absolutely confident that you would have been FAR more restrained then me. I have the least willpower where it comes it such things.

Just treat them as an extended experiments to work out the right stretegies for eating the same delicious things next year. I know I always do 😉

 

[everydayupsanddowns]

Thanks Jenny

Tweaked last night and went the other way today so back to the drawing board.

The other possibility that occurred to me was that perhaps I am rising am because i have been low during the night and the liver dumped some glucose, but it still does not account for rise late morning, or the rise that I had yesterday from 7:00 to 9:00 of five units without having eaten anything.

I have restored previous basal rates and will now wait until tomorrow before making any other changes as I shall have a Libre sensor active and Annan check what is happening overnight.

Hehe! Classic. Happens to me all the time. By the time I have decided whatever it is is a pattern and done something to fix it, blow me if my diabetes doesn't change its mind and do exactly the opposite of what I expect. Diabetes is a fickle adversary, that's for sure!

 

[SB2015]

There are times when I will 'audition' a comprehensive basal change by setting a 24 hour TBR of +/- 15-20% and then, if that seems to do the trick, I can adjust my patterns by the same amount using a phine calculator/bit of paper.

This is a very useful technique.
I like the idea of an 'audition' for the new basal rates.

 

[trophywench]

I'm trying to decide whether to thank Robin or cross her off my Xmas card list .....

I did actually think Robin that the unwritten code amongst ladies of a certain age was, that although the effects of age and gravity will no doubt be evident when we let it all hang out, that even amongst real mates who've seen it hanging out - we still didn't admit it in words - only by saying eg I'm looking for a new dress and I'd really like one with a bell-shaped sleeve - or at least an elbow length one!

 

[SB2015]

Just thank her. It comes to us all in time and as Robin said those wings are so useful for Libre users.

I had forgotten the thing about Libre readings going a bit odd if you lean on it. I must factor that in when discussing my readings with consultant. I wonder if he will be brave enough to mention Bingo Wings.

I still remember him in the early days of my diagnosis, trying to find a way of explaining why I did not need to worry as much about long term complications. Eventually I helped him out and suggested that it might be because I was already old when I was diagnosed. I have liked him from the start and this was a good ice breaker when I was feeling very anxious at the start of this long marathon.

 

[SB2015]

I was running high during the holiday period, partly because I ate more carbs than usual which confirmed my theory that basal requirements are affected by the total carbs consumed and therefore the fasting basal test mechanism is not always effective. I knew that once things were back to normal my requirements would drop again so I used temporary basal rates of 120% over a few days, with some success

Thanks for this Radders. A useful idea, and it is now written in our 'Cooking for Christmas' book where I have added some notes about the carbs for my home made mince pies, a slice of my husbands very nice Christmas Cake, brandy butter, ... yup all those things that I won't eat again until next year (or at least once they are all finished for this year (oops it is already 'next year').

 

[Sally71]

I very rarely bother with the faff of basal testing, unless things are going seriously awry! If we've had the same pattern for 3 days then I just adjust it anyway - consultant and DSN are aware of this and happy 🙂

 

[SB2015]

I think I now know why the consultant told me last time that he hardly ever gets anyone arriving at an appointment who has done a full 24 hour fasting test.

I think the LIbre makes things a lot easier and I shall use the data as well as some common sense to cautiously change things as necessary.

 

[heasandford]

I'm trying to decide whether to thank Robin or cross her off my Xmas card list .....

I did actually think Robin that the unwritten code amongst ladies of a certain age was, that although the effects of age and gravity will no doubt be evident when we let it all hang out, that even amongst real mates who've seen it hanging out - we still didn't admit it in words - only by saying eg I'm looking for a new dress and I'd really like one with a bell-shaped sleeve - or at least an elbow length one!

For Libre users I will add a piece of totally unnecessary information! - a friend gave me the nicest possible present, an elastic lace arm cuff, which covers up the Libre and makes me feel 'decorative'! I have been using tape and tubigrip to ensure the Libre stayed in place, ugly and draws attention to it, the lace cuff in beautiful beige is just lovely, and I am going to commission her to make me more to wear next summer! (I will just add that the reason she made it was because she'd been asked to make one for a friend's daughter who was having chemo treatment when also due to be a bridesmaid - to match the colour of the dress and hide the picc line, perfect)
I love my Libre despite its limitations and imperfections!