Type 1 on mdi - skipping meals and going hypo

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mum2westiesGill

mum2westiesGill

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Relationship to Diabetes
Type 1
So on mdi you can skip meals and don't do any bolus but recently I did and afternoon basal test and skipped lunch and didn't have any bolus but ended up hypo - it's almost like I have a strong feeling now that if I wanted for any reason to skip breakfast or tea I would go hypo when I look at my recent readings.
 
Remember Gill that diabetes is all about patterns, not one off events.
 
Gill, if you went hypo during a basal test then it strongly suggests that your basal dose is too high. That’s the whole point of the test, to see if your basal is holding you steady.
 
rebrascora said:
Remember Gill that diabetes is all about patterns, not one off events.
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When looking for patterns what are the things to look out for? Also how long ie days or weeks before you consider making a change? I might post some more bgls for some advice if that's ok.
 
Pattidevans said:
Gill, if you went hypo during a basal test then it strongly suggests that your basal dose is too high. That’s the whole point of the test, to see if your basal is holding you steady.
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Thanks @Pattidevans I've decreased it by just 1.0 unit so now I'll have to wait and see but I get so worried and anxious about it.

I only did 2 basal tests which were afternoon aka lunch and overnight.
 
If you’re going low when you’re not eating anything then your basal is too high, the whole point of basal testing is to find out whether it is correct or not and then make adjustments if necessary. If your basal dose is correct it should hold you pretty much flat the whole time, i.e. you end your basal test within 2mmol/l of where you started it and no big rises or dips in the meantime. If you drop then your dose is too high, if you go up then it’s too low. If you repeat the test and the same thing happens then that confirms it.

In terms of patterns, you’re looking for the same things happening every day. Do you go low or high at the same time every day regardless of what you’ve eaten? (Obviously you’re going to have a bit of a rise after eating but it should come down again before the next meal.) Have you skipped a meal/eaten late for a few days and always went low? Do you go low after meals regardless of exactly when you eat them, or go up and not come down again, which would suggest your carb ratio or timing might be wrong etc etc. If it happens once, ignore it. If the same thing happens 3 times in a row then you probably need to think about changing something.
 
16/11
23:14pm bedtime 4.6
18:50pm before tea 6.7
13:52pm before lunch 4.2
9:28am before breakfast 6.4
7:29am waking 5.8


Overnight basal test
05:03am 3.8
2:48am 4.4
23:43pm 5.1
23:07pm 4.8 start of basal test and bedtime


15/11
18:51pm before tea 5.1
14:16pm before lunch 5.4
10:50am 4.1
9:27am before breakfast 6.3
7:13am waking 5.8


14/11
23:36pm bedtime 8.3
19:58pm 4.5
18:57pm before tea 4.3
13:50pm before lunch 7.1
10:08am before breakfast 4.6
8:12am waking 4.3


13/11
23:46pm bedtime 8.4
19:21pm before tea 4.7


Afternoon basal test aka skipping lunch
18:10pm 5.4
16:09pm 8.7
14:05pm 9.5 start of basal test and before lunch


10:24am before breakfast 6.4
8:28am waking 4.1


Waking 5.8 / 5.8 / 4.3 / 4.1
Before breakfast 6.4 / 6.3 / 4.6 / 6.4
Before lunch 4.2 / 5.4 / 7.1 / 9.5
Before tea 6.7 / 5.1 / 4.3 / 4.7
Bedtime 4.6 / 4.8 / 8.3 / 8.4
 
Benny G said:
Good luck.
If you want to change basal just do half units or single units and wait a few days between tweaks.
They do just edge into hypo figures, but not by much.
Hi Gill, those numbers look really good.
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Thanks @benny-g
 
Did you read the instructions in the basal test info I sent you a couple of times about what to do with the results? I can find the link again if it helps, but it tells you what to do if you drop when not eating, says to reduce basal if you fall more than x points during a basal test. Then a few days later you would repeat the basal test and follow the instructions again until it says don’t change the dose.

There’s no point doing the skipping food part of the bolus test unless you’re also going to do the part where you act on results and change basal and repeat the test until your bg is steady!
 
Lucyr said:
Did you read the instructions in the basal test info I sent you a couple of times about what to do with the results? I can find the link again if it helps, but it tells you what to do if you drop when not eating, says to reduce basal if you fall more than x points during a basal test. Then a few days later you would repeat the basal test and follow the instructions again until it says don’t change the dose.

There’s no point doing the skipping food part of the bolus test unless you’re also going to do the part where you act on results and change basal and repeat the test until your bg is steady!
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Yes I read the instructions in the basal test info. Anything more than 1.6mmol - 2.2mmol might need to be adressed. The afternoon one fell by 1.0mmol and the overnight one fell by 4.1mmol!! I've reduced my basal by just 1.0 unit and will give it a good few days to see what happens then will repeat the tests.
 
mum2westiesGill said:
Yes I read the instructions in the basal test info. Anything more than 1.6mmol - 2.2mmol might need to be adressed. The afternoon one fell by 1.0mmol and the overnight one fell by 4.1mmol!! I've reduced my basal by just 1.0 unit and will give it a good few days to see what happens then will repeat the tests.
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Great, sounds like a good plan
 
Lucyr said:
Great, sounds like a good plan
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Thanks and how long would you give it until doing another basal test? I was thinking maybe next Monday or Tuesday.
 
At least 3 days is the usual guideline after changing doses of basal
 
Lucyr said:
At least 3 days is the usual guideline after changing doses of basal
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Tuesday was the first day of my reduced basal - reduced from 16.0 units to 15.0 units.
Before I go ahead and have some breakfast is it too soon to do a morning basal test this morning?
 
That’s your decision Gill. It has been more than 3 days since Tuesday.
 
Lucyr said:
That’s your decision Gill. It has been more than 3 days since Tuesday.
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Thanks and I'm currently doing a morning basal test. I just hope I'm doing it the right way which is - my last meal and bolus was teatime yesterday then I did my waking test and basal this morning then started my morning basal test at 9:27am. I'm hoping to carry it on until around 1pm - 2pm ish when I will have my lunch.
 
mum2westiesGill said:
Thanks and I'm currently doing a morning basal test. I just hope I'm doing it the right way which is - my last meal and bolus was teatime yesterday then I did my waking test and basal this morning then started my morning basal test at 9:27am. I'm hoping to carry it on until around 1pm - 2pm ish when I will have my lunch.
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Does this sound ok?
 
Hi @mum2westiesGill You might find this link useful for a perspective on what you are doing.

Basal Testing for MDI

Basal testing is a technique that came into its own with the advent of pumping. But it also provides useful insights into managing basal requirements under MDI. This has become particularly problematic with the advent of modern flat-acting basal insulins (Lantus and Levemir). If you are on MDI...
www.diabetesdaily.com www.diabetesdaily.com
 
Sounds like you are getting some useful information @mum2westiesGill

Hope the dose tweaks work out well 🙂
 
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