How to set basal level?

[Katiemorag]

Hi

Can anyone give me a real noddy walk through on how to check if my basal is right? My control is shot to pieces and I want to try and "start again".

Can anyone tell me how to do fasting tests? When to do them, how long do you fast for? What does a good result look like?

Thanks to anyone who can guide me through it.

 

[mo1905]

To test basal basically set a time to eat/inject qa say 8am. hard bit is to not eat for 5 hours. (some would say 4 hours but me thinks qa can last up to 5). This is to make sure all carbs eaten at 8am have fully digested and all qa insulin has been used. If you need to treat a high/low abandon test.
Assuming all is good till 1pm, no other food/sugary drinks consumed take a reading at 1pm. Hopefully it will be between 5 and 8. Record readings every hour from 1pm till 5pm. You wil then see what effect your basal has on your levels. I do 4 hours fasting as you can then split the 12 hour day into 3, 4 hour slots.
Only miss 1 meal a day as going much longer during the day would give inaccurate readings as the liver would overcomponsate.
To do morning basal test best just to wake up at your usual time and record readings every hour till lunch if poss till 1pm.
To do evening meal have lunch at say 1pm, test every hour from 6pm till 10\11pm. During any test abandon if needing sugar/carbs or correction bolus. Adjust qa next time for meal previous depending on results and try to repeat test another time. Doing the above would give you fasting readings for the while day. Doing this will give your fasting day time readings on different days from 8~1, 1~6, and 6 till 10/11pm giving a whole day profile pic your basal.
The night time one involves eating at say 6pm, again consuming nothing till 11pm. carry on starving and take readings every 2 hours through the night as 1 hourly can be exhausting.
Same way applies to pump and mdi, however pump easier to componsate for changes needed as can be done hourly without effecting other parts of the day.
For example on mdi you may find you need more basal in the middle of the day, but, if you increase your basal you would be having too much through the night.
Hope that explains it, anything unsure of just ask


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[mo1905]

That was given to me by Brett and it worked for me


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[Daibell]

HI Mo has given you the best and most accurate approach. A rough check which I do based on once a day evening Basal is to check that my morning fasting reading is between 5 - 7 mmol. If you have split doses or inject in the morning then follow Mo's advice. Advice for fasting time varies amongst HCPs but in general fast between 10 - 12 hours. A phlebotomist once told me going beyond 12 hours risks a liver glucose dump. Some would say even 8 hours is long enough but go for 10-12 hrs as a general rule

 

[iHs]

Im a bit puzzled as to why diabetics using injections are bothered about testing out their basal? Pump users need to do it but its hard for those injecting lantus, levemir etc to do it and get ok bg levels. Even adjusting it, doesnt always have the desired effect, whereas adjusting the bolus usually does. Are doctors instructing people to do this or is it a forum thing?

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[mrman]

I was advised by my hospital team to do so they could see what my basal was like pre pump. Did help them to say I needed a pump
On mdi it can be also useful for a few other reasons. Main one would be to derermine the timing of basal injection, ir, if it would be beneficial to do a split dose weather it be 50/50, or 70/30.



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[iHs]

Did you adjust the basal then after testing it out? Also, just how often were you testing yr bg and adjusting the carb and bolus?

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[mrman]

Did you adjust the basal then after testing it out?
On mdi I did, I found I was low early hours, but not enough in the morning. So, added 2 units and moved my basal injection to immediately before bed. This did prevent the low during night, better after breakfast readings (but still a bit too high), but, due to the increase I always had a low 4~5 hours after lunch. Needed 20~30 carbs 2~3 hours after lunch to last till tea. Couldn't reduce the qa at lunch as I would be in the teens otherwise.

Also, just how often were you testing yr bg and adjusting the carb and bolus?
Have always tested before and 2 hours after food. Don't need to change ratios that often but, I would try adjusting bolus to see if that would work first, beyer basal checking





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[mo1905]

Im a bit puzzled as to why diabetics using injections are bothered about testing out their basal? Pump users need to do it but its hard for those injecting lantus, levemir etc to do it and get ok bg levels. Even adjusting it, doesnt always have the desired effect, whereas adjusting the bolus usually does. Are doctors instructing people to do this or is it a forum thing?

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Those on MDI need to set basal correct so they can vary day to day living. Quite often I'll skip a meal or eat at different times. If basal is wrong and I skip a meal my BG could steadily rise or fall if it was wrong. We are taught to set basal correctly, before bolus ratios. That way, if I skipped a meal or had a very low carb meal my levels should remain steady.


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[hale710]

Im a bit puzzled as to why diabetics using injections are bothered about testing out their basal? Pump users need to do it but its hard for those injecting lantus, levemir etc to do it and get ok bg levels. Even adjusting it, doesnt always have the desired effect, whereas adjusting the bolus usually does. Are doctors instructing people to do this or is it a forum thing?

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On DAFNE they recommended we did it. If your basal is wrong you could have hypos overnight so they want to rule that out. Those on split basal have slightly more flexibility so testing during the day gives greater accuracy to that too


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[iHs]

Ok lol Lets hope that everyone is able to maintain the control and that it wont change

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[Daibell]

Hi iHs. Yes, it's important and fairly easy to set your Basal. The reason is to match the drip-feed of glucose from the liver. As others have said, set it too high and you have hypos and too low your blood sugar is higher than needed. Bolus is purely to match meal content (or correction if you get it wrong). Bolus has no other function.

 

[iHs]

I dont need lecturing Daibell thanks.... ive been type 1 for a very very long time.

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[hale710]

Ok lol Lets hope that everyone is able to maintain the control and that it wont change

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Of course basal requirements will change! But the purpose of the basal test is to help determine what that change will be I would have thought?


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[mo1905]

That's why we test and monitor our BG levels. How many times has yours changed Hale ? Mine has changed on many occasions. The trick is to spot the signs and adjust !

 

[hale710]

That's why we test and monitor our BG levels. How many times has yours changed Hale ? Mine has changed on many occasions. The trick is to spot the signs and adjust !

Yep I change my basal continuously. Thankfully my bolus ratios haven't taken much tweaking yet (only twice in a year) but I put that down to keep my basal right (or trying to!)


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[donnellysdogs]

If you were non diabetic liver and pancreas balances ok..... Lucky beggars!!!

**** hard if type 1 diabetic!!-lol!!

Some people can work good at 50/50 ratio some are 40/60 or 60/40 etc. depends all upon body fat mass, exercise stc.

Things progressed in last 30 years.. I was never told to basal test on mdi... So things have changed iHs since our mdi days!!-lol!!! Good if it works.. I still have feet, legs without basal testing... But as you know almost lost my driving licence (will never forget your support to me!!).




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[donnellysdogs]

Insulins never work at a constant rate.....it all depends on the individual body!! How I wish people could understand this.......

If a type 1 basal tests.... The results are reluant upon activity...ie

You can start at 5.0 do nothing and levels stay good...

You can start at 5.0..... Exercise and walk and your levels could drop... Or rise.. Because of your body fat mass and and your individual liver and stress and heat etc....

There is not a 'brilliant dosage system for all"- we are all individuals...


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[mo1905]

That's why we continually test and adjust ! Nobody is saying a certain dose should be fixed, even basal. If our doses and ratio's never changed, diabetes would become boring ;-)

 

[mo1905]

^ yes, that's the point. There are so many factors that affect the "efficiency" of the insulin hour by hour and day by day, I'm puzzled as to how a basal dose of long-term-acting can be expected to work. Although I've been diabetic for 45 years, I've only been on these analog insulins (Lantus, Levermir, Novorapid) for the last 5 years, and somehow I think that the notion of multiple dose Novorapid is ok, but a constant dose of basal is a flawed concept.

It's not really flawed, it's an approximation of how much insulin is required for an individual on an "average" day. It's not set in stone but it's a base.