Has anyone done the carb free test - MDI?

[linda_b]

Hi all,

I had a dietician appointment on Wednesday and we discussed that I'm unhappy with Lantus. After observing my readings she thinks it could be possible that my basal needs changing. In order to determine this I need to do a carb free/no bolus test. On separate days I need to eat a carb free breakfast/lunch/dinner and inject no bolus to see if my basal keeps my glucose even. I'm really nervous to do this, firstly I've previously suffered from Diabulmia and I'm worried not injecting may trigger something and secondly I'm worried as I know that if I don't give myself bolus despite the meal being carb free my sugars will rocket.

Has anyone done this test before? How did you get on with it?

 

[Kristin251]

I have not done it but I would rocket too. Protein turns to bs almost as fast as crabs for me. The only thing I could eat to not rocket would be avocado or egg yolk with mayo. I'd still go up. My lantus doesn't do anything during the day. I just use bolus for the day and lantus to keep me steady from 10 pm until I wake up.

What aren't you happy about with lantus?

 

[Sibyl]

Why carb free breakfast and not a fast from 8pm till lunch the next day? That's what I was asked to do. I told my team that even a "no carb" breakfast will make me rise and they said that's not unusual. New school of thought suggests ALL food can cause some rise.

 

[noblehead]

I couldn't do a carb-free basal check as eating any food would result in a bg rise, most type 1 literature will tell you that a basal check has to be a fasting one where no food is eaten during the check.

Edit to add a link to basal testing:

https://mysugr.com/basal-rate-testing/

 

[azure]

Hi all,

I had a dietician appointment on Wednesday and we discussed that I'm unhappy with Lantus. After observing my readings she thinks it could be possible that my basal needs changing. In order to determine this I need to do a carb free/no bolus test. On separate days I need to eat a carb free breakfast/lunch/dinner and inject no bolus to see if my basal keeps my glucose even. I'm really nervous to do this, firstly I've previously suffered from Diabulmia and I'm worried not injecting may trigger something and secondly I'm worried as I know that if I don't give myself bolus despite the meal being carb free my sugars will rocket.

Has anyone done this test before? How did you get on with it?

As @noblehead has said, a normal basal test is no food of any kind, with the day split into segments so you don't get too hungry. If you're not happy with the suggested method or just not happy with doing any kind of basal test because of your previous problems, I think it's important to say so.

If you're not happy with the Lantus, I don't see why you can't change without having to do a basal test. I'm on a pump, but I changed my insulin without a basal test after discussion with my consultant.

 

[GrantGam]

Carrying out the test in which your dietician has outlined (not quite sure how she has the say to authorise such a practice?) would result in terrible BG for me.

As @Kristin251 has said, protein turns to glucose for a lot of us T1's, especially when we low carb and don't take bolus insulin.

Furthermore, your TDD (total daily dose (basal + bolus)) would change when you drop the carbs from your diet. A change in TDD almost always results in a change in basal dose requirements. Considering that a typical basal dose is usually somewhere around 50% of your TDD, the chances are you'll need significant less basal insulin and may run into frequent, and possibly nasty hypos.

IMHO, your dietician advising you to carry out such a basal rate test is daft, for more reasons than one. A basal test, as suggest by @azure, is usually conducted over a series of days and comprises of 4-6 hour fasting segments within each 24 hour window. Your basal testing should always be based around a typical daily carb intake for you, this helps to set your basal dose for what is a usual day of eating for you. I can guarantee that if you try and set your basal dose from a few days eating zero carb, it'll be wrong and completely out of balance when you try to apply that basal dose to your normal carb intake.

I'd conduct the test from the link provided by @noblehead and forget what your dietician has told you. I'd also request input about diabetes from those more qualified (your diabetic specialist and DSN) - dieticians know diet, not diabetes. Otherwise they'd be diabeticians right?

 

[linda_b]

I have not done it but I would rocket too. Protein turns to bs almost as fast as crabs for me. The only thing I could eat to not rocket would be avocado or egg yolk with mayo. I'd still go up. My lantus doesn't do anything during the day. I just use bolus for the day and lantus to keep me steady from 10 pm until I wake up.

What aren't you happy about with lantus?

Hi Kristin,

I've been on it for years and over the last few years I just can't get the dosage right. The dietician said that basal is supposed to keep in your system for 24 hours so if you do miss a meal etc it will keep glucose steady but I've never been able to go with bolus even if I don't eat my sugars go up regardless. So confusing!

 

[linda_b]

Carrying out the test in which your dietician has outlined (not quite sure how she has the say to authorise such a practice?) would result in terrible BG for me.

As @Kristin251 has said, protein turns to glucose for a lot of us T1's, especially when we low carb and don't take bolus insulin.

Furthermore, your TDD (total daily dose (basal + bolus)) would change when you drop the carbs from your diet. A change in TDD almost always results in a change in basal dose requirements. Considering that a typical basal dose is usually somewhere around 50% of your TDD, the chances are you'll need significant less basal insulin and may run into frequent, and possibly nasty hypos.

IMHO, your dietician advising you to carry out such a basal rate test is daft, for more reasons than one. A basal test, as suggest by @azure, is usually conducted over a series of days and comprises of 4-6 hour fasting segments within each 24 hour window. Your basal testing should always be based around a typical daily carb intake for you, this helps to set your basal dose for what is a usual day of eating for you. I can guarantee that if you try and set your basal dose from a few days eating zero carb, it'll be wrong and completely out of balance when you try to apply that basal dose to your normal carb intake.

I'd conduct the test from the link provided by @noblehead and forget what your dietician has told you. I'd also request input about diabetes from those more qualified (your diabetic specialist and DSN) - dieticians know diet, not diabetes. Otherwise they'd be diabeticians right?

Thanks for the detailed explanation I really appreciate it. I'll take a picture of the form I've been told to fill in.
The way I see it if I'm as uncomfortable about doing this test as I feel then I shouldn't do it and if I do do it and I'm stressed thinking about it that's going to raise my levels anyway.

 

[GrantGam]

Thanks for the detailed explanation I really appreciate it. I'll take a picture of the form I've been told to fill in.
The way I see it if I'm as uncomfortable about doing this test as I feel then I shouldn't do it and if I do do it and I'm stressed thinking about it that's going to raise my levels anyway.

What I've said in my post is purely my beliefs and taken from my personal stance as I know what works and what wouldn't work for me. What I would definitely advise though, is that if you are going to be carrying out any basal rate testing; then to use the link which @noblehead provided

 

[himtoo]

Hi @linda_b
I just came across this thread just now

how did you get on with basal testing ?

do you keep in regular contact with your DSN ( diabetic nurse ) ?

it is not loads of fun when you feel as though bloods aren't behaving .
and with the history you mentioned you are very wise to question the advice given by the dietician .

 

[linda_b]

Hi @linda_b
I just came across this thread just now

how did you get on with basal testing ?

do you keep in regular contact with your DSN ( diabetic nurse ) ?

it is not loads of fun when you feel as though bloods aren't behaving .
and with the history you mentioned you are very wise to question the advice given by the dietician .

Hey sorry for delay! I'm getting on ok with it. I decided to do a complete fast instead of just a carb free meal. So the overnight one was what I expected hypo all through night and then Dawn Phenomenon in the morning.

Breakfast (different day) started at 6.7 by the time lunch hit I was 13.2

Yet to do lunch and dinner. I'm off work next week so I'm thinking it might be easier to do and focus on if I'm at home.

I'm emailing my nurse and dietician they've been great and I'm seeing them on 28th April to report back.

 

[himtoo]

morning linda !!
not wishing to be cheeky but..............

if you experience a hypo during a fasting test you really should abandon the test and treat the hypo
( if you are using a libre and basically slept through the hypo that is an eeek( not good ) )

totally agree with the more time to conduct basal testing when at home and off work.

excellent news on the emailing and further appointment with your DSN and dietician !!

this D is a marathon so just taking things slowly and not trying to fix everything at once is really important in keeping the mental side of things on track too. ( rome wasn't built in a day so to speak )

great news all round though - I really hope you can get some progress soon !!

 

[azure]

Sounds like you're doing a good job of all the testing @linda_b

I find basal testing can take a while so don't worry about getting results over a few weeks. It's not the most fun thing to do either!

 

[abigail0432]

I have done one of these before it's not as bad as it seems. If you go carb free the whole day do your lantus as normal and check often if you find you go to high just do the correction ratio that they give you and tell them when it happened as it will prove you need to change things it's a slow process but it really does help getting an understanding of how your insulin is working. And try not to worry take your fast acting if you need to and just check often