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Type 1 Understanding Basal test results

SRO

SRO

Well-Known Member
Messages
89
Type of diabetes
Type 1
Treatment type
Insulin
Hi all,

I'm currently basal testing to get things under control. Today's my first day.
Looking for some help on the results so far, though...(Note, I don't correct as my levels are higher than normal for now).

8am: 16.6 mmols (fasting from last night).
Breakfast 20g Carbs - 2u Novorapid / 20u Levemir.

10am: 16.3 mmols.

12pm: 14.8 mmols.

2pm: 12.5 mmols.

4pm: 12.8 mmols.

My last fasting reading will be 6pm.

I will repeat tomorrow to make sure I'm getting similar readings, but am I correct in thinking my Basal needs to be reduced as I've went down more than I should?

Thanks very much.
 
You are correct in thinking your basal level is too high, however, you need to be careful. At higher blood glucose levels it typically requires more insulin to lower your levels. As a result, while your basal test reveals that you are using too much basal, you can't tell how much as your high level hides how much your bg would drop if you started the basal test at 8 mmol/l.
 
Thanks @tim2000s.

My final reading (at 7pm, not 6pm as planned) was 9.4.

Is that the reason for ensuring the test starts under 14 mmols?

I'm hopeful that I will be under 14 in the morning, so I will retry and see how I get on.

Thank you for the info.
 
Are you injecting levemir once a day or twice a day?
 
Hi @donnellysdogs

I inject Levemir twice daily. 8am and 8pm.
I am still around 9.5 so fingers crossed I don't hypo overnight. Got some sweets next to me just in case.
Reduced my dose to 17u for tonight.

I will get the hang of this eventually.
 
Hi @SRO

Its not uncommon for type 1s to inject more basal in the morning and less in the evening but its all about getting the balance between the basal and the bolus ok to achieve the correct bg levels. Although your bg is going lower in the afternoon, adjusting the morning basal downwards will probably start to make bg levels go up higher late mid morning so to compensate, more bolus will need to be used at breakfast. See what I mean about getting the balance right??
 
@SRO apologies if I missed something but why are you not taking a correction bolus to bring you down from what are quite high BGs in the morning?
If you are going hypo overnight then you maybe should do overnight basal test and see what is happening there as the priority.
 
Thanks guys.

@iHs I've reduced my basal this morning to see what happens. Here's another hungry day ahead! haha! Fingers crossed I'm a bit closer to getting it right.

Hi, @steve_p6 I don't know my insulin:carb ratio, nor how much it brings me down just yet. I'm not long diagnosed so feel like getting these basals right will send me on a good route forward.

Last night I went to bed on a 9.7 and felt that I would go too low, and I was right. Woke up at 3.30am on 4.7.

Getting there slowly...
 
You'll get there... You are going on the right tracks.

Many of the DSN's etc don't talk about basal testing to people on MDI... It is a good way to find out exactly how your bloods work.

Ie long term if you get a high say of 12.0. Do your normal correction and don't eat.. You would want to be back in target range by 5 hours..... However... For some people with levels above 12.0 you will need more insulin than a normal correction dose.

I've wandered off at a tangent there.....but I'm just really trying to say its early days.... Use everything as a learning tool....

As a generalised tip only...if your levels change up or down 2-3hours only after a bolus then it is more than likely the bolus..
 
Thanks @noblehead - registered and i'll get learning! So many tools!

Cheers @donnellysdogs - I ate 2U/20g carbs for breakfast, and my 2 hour after eating reading went from 8.9 to 12.1! I'm thinking my ratio definitely isn't 1:10 if that's what I'm getting. I'll check again at 12pm (4 hours after) and see how I'm doing.
 
At the moment your 1u to 10g carb is obviously not correct but once you get the TDD correct between the basal and the bolus, then 1u to 10g might be correct or might need to change to 1u to 8g or maybe 1u to 7g.
I posted a msg on the forum last night explaining the correction factor
http://www.diabetes.co.uk/forum/threads/suger-levels-high.94249/#post-1066507

In general most people will need something like a 50/50 split between the basal and the bolus. Its thought that for a normal weight person, 0.5 to 1.0 of insulin per kg bodyweight is a good starting point. For those who are overweight or have heavy bones etc, they will need about 1.0 to 2.0u per kg bodyweight. So whatever a persons bodyweight is, the rough TDD insulin can be calculated and from that, 50% can be used for the basal and the other 50% divided up over 3 meal bolus's. Some people decide that the 50% basal dose works better if its divided up over 2 doses - morning and evening and some find it works better to use more basal for morning jab and a bit less of it at night.

Its very complicated initially but do register on the BDEC website and then you will start to understand my msg and what over posters have said.
 
SRO said:
Thanks guys.

@iHs I've reduced my basal this morning to see what happens. Here's another hungry day ahead! haha! Fingers crossed I'm a bit closer to getting it right.

Hi, @steve_p6 I don't know my insulin:carb ratio, nor how much it brings me down just yet. I'm not long diagnosed so feel like getting these basals right will send me on a good route forward.

Last night I went to bed on a 9.7 and felt that I would go too low, and I was right. Woke up at 3.30am on 4.7.

Getting there slowly...
Click to expand...
@SRO understand your caution with correction doses. I think you should set your alarm clock and do dome testing every two hours through the evening and night. (Check the links on how to do this). It sounds like your nighttime levemir may be a bit high and the morning high is probably an overcorrection - how do you treat your nocturnal lows, how many carbs?
 
steve_p6 said:
@SRO understand your caution with correction doses. I think you should set your alarm clock and do dome testing every two hours through the evening and night. (Check the links on how to do this). It sounds like your nighttime levemir may be a bit high and the morning high is probably an overcorrection - how do you treat your nocturnal lows, how many carbs?
Click to expand...

Hi @steve_p6 I don't really have lows, yet. My 3 month target is in the 12's because I was so high for so long - so I do struggle a bit to get lower readings (but not overly concerned right now).
I have had one hypo when I miscalculated my carb intake - and got down to 3.3.
When I tested in the middle of the night (at 3.30am), I was 4.7 (from a 9.something at 11pm) - ate 5 jelly babies and woke up (6.30am) with a 6.6. By the time I got to work, I was up to 8.9.

From the tests I'm doing, I realise that my Levemir is definitely too high both doses. This morning I took 12U, rather than 17, and after 7 hours, I'm around 1mmol/L higher than I was this morning, so I'll see how this goes for the next 4/5 hours.

I'm starving, but it's very interesting to see how wrong I think my dose is. My problem was probably eating too many carbs, masking the basal count.
 
I had to completely rethink my basal/bolus last summer reduced by nearly a third then it all went back to what it was over the winter!! Sounds like you are getting a handle on things thouhh, starvation unfortuneately is only way for basal tests as even carb free snacks can trigger a BG rise.
 
So an update this morning - I think I've got my morning correct. 12U was just slightly out (by 1.5mmol/L), so I'm going to settle for 11U for now - but keep my eye on it.
Night, though, seems like it's going to be a bit higher. I did make the mistake of having a high fat snack so think this may have had an impact, but I still woke up only 3mmol/L higher than when I went to bed - so maybe a 13U (rather than the 12U I tested last night).

Last week I was on 20U morning and night, so that's a huge change.

Next on the list is getting the carb ratio correct! Wish me luck!
 
Sounds great @SRO . It's great to be able to take this into your own hands and see the results! Good luck with the I:C testing...
 
iHs said:
At the moment your 1u to 10g carb is obviously not correct but once you get the TDD correct between the basal and the bolus, then 1u to 10g might be correct or might need to change to 1u to 8g or maybe 1u to 7g.
I posted a msg on the forum last night explaining the correction factor
http://www.diabetes.co.uk/forum/threads/suger-levels-high.94249/#post-1066507

In general most people will need something like a 50/50 split between the basal and the bolus. Its thought that for a normal weight person, 0.5 to 1.0 of insulin per kg bodyweight is a good starting point. For those who are overweight or have heavy bones etc, they will need about 1.0 to 2.0u per kg bodyweight. So whatever a persons bodyweight is, the rough TDD insulin can be calculated and from that, 50% can be used for the basal and the other 50% divided up over 3 meal bolus's. Some people decide that the 50% basal dose works better if its divided up over 2 doses - morning and evening and some find it works better to use more basal for morning jab and a bit less of it at night.

Its very complicated initially but do register on the BDEC website and then you will start to understand my msg and what over posters have said.
Click to expand...

Hi @iHs

Can I just ask you about this BIB, please?

I'm ~85Kg (when I don't snack ;)), and found out that Basal is now 24U per day (11U + 13U).
So, should I be averaging 8U for 3 meals? If I work out my carb ratio is 1:5, then I should be aiming for no more than 40g of carbs per meal?

That's tough going, but if it gets me in a good place - then it's worth a try.

Is that right, though?:)
 
Thanks @tim2000s - Didn't expect to get to this stage when I was celebrating Christmas with a DKA 7 weeks ago - so I'm happy that it's making a bit more sense!
Thanks hugely to this forum, I must add!
 
This might be helpful to you @SRO: http://www.imperialendo.com/for-doctors/guide-to-cho-counting

It's a guide to carb counting. Typically, what I like as a way of confirming I:C ratio is to use pure glucose (i.e. dextrosol tabs as they are a specific amount per tab), then, from a fasted state, start at an assumed 1u per 10g carbs.

Give your self 1u of insulin, wait 15 mins and take 10g of glucose. Then see where your level is at 2 and 4 hours post eating. If it has come back to more or less the same as pre-eating, then you are good on your ratio. If it is higher at 4 hours, then you need more insulin and lower, then you need less.

It's a bit trial and error, but you'll get there. You may find that you have to adjust it at different times of the day.

The rule of 100 is what you'd use for establishing a correction dose.
 
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