Increasing basal to combat fasting highs....

[Albee7740]

I seem to have a consistent pattern of high fasting blood sugars. I tested at 1am and was at 6.1 so I don't think the morning high is due to a hypo in the night. So my thinking is that I need to increase my basal insulin gradually and see what that does. In my mind if I am taking a higher basal dose then I won't need as much in terms of fast-acting insulin with meals to keep me in range? Could I potentially (eventually) just have the basal and no bolus?

 

[slip]

Basal should keep your BGs level and stable whilst fasting - look up 'basal testing'.

Your thinking is correct.

If you are upping your basal be aware your bolus ratio may need tweaking as you may have being compensating for the lack of basal with bolus - so keep testing regularly.

Some would say as a T2 going LCHF would mean you could come off insulin all together......

6.1 isn't too bad at all, how are your numbers generally?

 

[Albee7740]

Thank you for the info slip - very much appreciated. So my simple understanding after googling "basal testing" is that if during a period of fasting my blood sugars creep upwards then my basal dose is probably set too low - is that right?

Ideally I would love to come off insulin (and all diabetes meds - still taking 2000mg of metformin) but the diabetes specialist said that because we are trying to conceive he wants me to continue to have tight control over my blood sugars and the best way to do that is to continue to take insulin.

With regards to my numbers generally, over the past week I have averaged 6.4 with a range between 3.9 and 9.5 but generally between 5-6, but I have been giving myself "correction" bolus doses .....

 

[slip]

if during a period of fasting my blood sugars creep upwards then my basal dose is probably set too low - is that right?

Yes basically, plus lots of testing. The period of fasting should be so that you have no on-board insulin (other than basal) and food that could affect the result. For example if you can start basal testing the morning first - thats easy, well easier! because you don't usually eat when you're a sleep and have no insulin on-board so skipping breakfast and not eating until lunchtime gives you a large fasting period, you then need to do a fasting from lunch time to evening meal (if you can have a breakfast that you know you can cover and get right) the next day and then skipping your evening meal the next will give you a good idea how your basal is working through out the whole day. Which basal are you on?

With basal testing it is always easier if you have a CGM type device, less finger pricking and a fuller picture - Abbotts Freestyle Libre is probably the most cost effective.

Once you have your basal stable then you can work on getting your bolus ratio's tied down and nail that tight control. You're doing great though judging by those numbers anyway.

 

[NaijaChick]

Your doctor is right as you are TTC. Insulin is the best way to get the tightest results. Good luck

 

[Albee7740]

So I have tried to increase my basal dose by 4 units and my BG is till in the 7-10 range in the mornings - if the basal dose is correct what would you expect fasting BG to be in the morning?

 

[slip]

Hi Albee7740, have you given your new basal time to settle in? (3-4 days). As for morning BGs it does depend a lot on what it was the night before and also what sort of (evening) meals you have - pasta or pizza for example are difficult to dose correctly for and have a longer lasting affect on BGs - I know if I have things like that I can expect my morning BG to be raised even if I ace the dose before bed.

I still think a basal test would be a good thing for you to do.

 

[Albee7740]

Hi Slip, I gave the new basal a week and I don't eat pasta or pizza as I am on a low carb diet. My mum has been in hospital and so it may be down to stress that I have had higher readings generally (only slightly). I guess I am trying to work out how I will know that my basal dose is set correctly - I imagine that if upping the basal dose brings my fasting BG down, it would also mean that I have a higher 'background' dose overall which could lead to hypos if I understand it correctly?

 

[slip]

Sorry to hear your mums been in hospital (hope all is well or at least on the mend now) and yes stress could be the culprit.

So the basal is there to keep you level, if your bedtime reading and morning readings aren't usually similar (within 1mmol?) then your basal isn't correct - note I said usually as we all get some out of whack results sometimes. Just having a quick flick back up the thread you've never mentioned what your bedtime results are like, for all we know you could be going to bed on an 8 and waking on a 7 or 8, or you could be going to bed on a 10.......

I imagine that if upping the basal dose brings my fasting BG down, it would also mean that I have a higher 'background' dose overall which could lead to hypos if I understand it correctly?

correct, especially if your bolus ratios were also helping for the lack of basal previously, keep testing and stay safe.

 

[Albee7740]

That's really helpful slip

I've generally been doing my last test at 20.30ish but don't go to bed until 22.00-00.00 most nights. Around 20.30 my BGs have been 6.8 and waking they have been 7.8 on average according to the contour app I've started to use - so I guess its within the 1mmol you mentioned - I have cut out all obvious carbs and don't eat alot of fruit so I'm not sure what more I can do - maybe I just need to accept those numbers as ok for me but its just frustrating when I have the occasional 9 or more in the morning when I am working so hard to control things......