1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2020 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Basal testing failures and hypos

Discussion in 'Type 1 Diabetes' started by paulpapa, May 20, 2017.

  1. paulpapa

    paulpapa Type 1 · Well-Known Member

    Messages:
    94
    Likes Received:
    76
    Trophy Points:
    58
    Hi all,

    I've been trying to sort my basal rate on my pump for a fair few nights now by doing overnight testing. But the last two times I've tried, I'd either been too high to test or went hypo after dinner before the pre-bed blood test. It's really frustrating me as on these basal test nights I carb count my meals so methodically and eat a relatively small meal, so I'm hungry by the time I go to bed (I usually carb count like a scientist anyway but I eat a bit more).

    I'm just so sick of waking up high and starting the day off negatively with a fat correction bolus and a delay in eating anything, generally to about 11:30 or 12. The rest of the day seems pretty good; lunch in particular seems to work well for me.

    I'm just thinking perhaps I should bolus less with my evening meal for the next night in the hopes I don't hypo and am able to do the test. Maybe do a reduction by one or one and half units so I can see where things get me? I know it's not exact but then I can tweak the evening ratio properly once the overnight is better.

    Any tips on overnight testing? Any meals you have tried that seem to work well before it?

    I'll be honest, I did swear quite loudly when I felt the hypo coming on and even more when I gave in and tested and was 3.7. I then ate something and bolused for it as I was hungry only to be 2.8 in the night. I'm guessing that the nighttime ratio need to be reduced as it was quite a marked drop from the 7 I had and 30g of carbs.

    I've had to cough up for a Libre to see if it'll help me with the overnight data as I need to be able to fix this.

    Sorry for this ramble... just feeling frustrated.

    Thanks,

    P
     
  2. catapillar

    catapillar Type 1 · Well-Known Member

    Messages:
    3,391
    Likes Received:
    2,891
    Trophy Points:
    198
    If you're starting an overnight basal test at 10pm you should bolus and eat dinner by 6pm at the latest. So you could try late afternoon snack and bolus, skip dinner altogether. Or you could just eat and bolus for dinner as normal before the basal, but obviously make sure your moving that early enough not to interfere with the overnight basal test. I don't think there's any particular reason to eat less prior to starting a basal test. If your usual dinner normal works well, no hypos, just have your usual dinner but earlier.

    Or bolusing less with dinner pre basal testing sounds sensible too.

    Youre supposed to start off a basal test euglycaemic, not hypo, not hyper. So somewhere between 4 and 10. And youre not supposed to have had a hypo in the preceding 24 hrs, because you've got counter regulatory hormones and vulnerability to further hypos hanging about that might interfere with accuracy.

    Basal testing is frustrating, it was a very restrained ramble.
     
    • Like Like x 3
  3. noblehead

    noblehead Type 1 · Guru
    Retired Moderator

    Messages:
    23,621
    Likes Received:
    19,617
    Trophy Points:
    278
    Sounds good, once you get your overnight basal rates right you can then look at your evening I:C ratio.

    As @catapillar says, you don't need to starve yourself, just make sure that the meal is low in fat and leave a 4 hour gap before basal testing, when I do an overnight basal check I just have a meal like boiled potato's, veg and chicken.

    I've used the Libre, personally I'd still do a bg test as well before making any adjustments to your basal rates, I wouldn't rely solely on the Libre in other words. Good luck.
     
    • Winner Winner x 1
  4. paulpapa

    paulpapa Type 1 · Well-Known Member

    Messages:
    94
    Likes Received:
    76
    Trophy Points:
    58
    Thanks @noblehead and @catarpillar. Went hypo again today so that's tonight out. I knew that having a hypo meant I couldn't do a test but couldn't remember why so thank you! I'll try again next week and have a normal sized, but low fat meal and see what happens.

    I agree about the Libre. It was more just to get more data and trends anyway. I'm finding the high sugars, even without hypos are the norm in the morning so I'm keen to crack this. Just wanted to see when the rises were occurring so I could increase the amount very gradually.

    Thanks again.
     
    • Friendly Friendly x 1
  5. himtoo

    himtoo Type 1 · Well-Known Member
    Retired Moderator

    Messages:
    4,675
    Likes Received:
    5,405
    Trophy Points:
    198
    not sure if this will help-- when I started on a pump 20 months ago my evening ( 6:30pm ) basal dose of lantus was 32 units.

    my DSN started me on my pump on a flat 12u per day ( o.5u per hour )
    needless to say after the first week I was ready to throw it in the bin because my BG's were always above 10 ( more around 15 - 18 )

    but over the next 3-4 weeks between us we made many adjustments along with loads of basal testing and my basal is currently about 24u per day with a low period in the afternoon of 0.6u per hour peaking at 3am when it hits 1.65u per hour
    I do not have many hourly periods where my basal stays the same( 10 different rates in 24 hour period ) -- but this was only gleaned by really rigorous testing. I know we are all different and perhaps yours do stay fairly flat .

    it does not seem that every DSN in the country follows this sort of startup from what I have gained in speaking to a fair few people on the forum

    so ----- perhaps maybe start from scratch at around 40% of your previous basal insulin dose and work through it all over again and build your individual pattern -- sorry -- I know this is not a user friendly answer and a pain in the arse
     
    • Like Like x 1
    • Informative Informative x 1
  6. iHs

    iHs · Well-Known Member

    Messages:
    4,603
    Likes Received:
    2,320
    Trophy Points:
    158
    It took me ages to get all of my basal rates okish....I was either going down to 4mmol so had to stop the test or going up to 9mmol so stopped. In the end, I staggered the times that I had food with a bolus by 2.5hrs so instead of eating at 6pm, I had a meal at 8.30pm which allowed me to get about 3hrs worth of basal rates ok. I also kept my carb lowish to 20g for each meal to try to prevent going really high. For the low bg, I quickly realised that on a pump unless there is a lot of bolus active, most low bg can be fixed with just 1 or 2 jellybabies. It's different on MDI.

    I used Gary Scheiner guide to basal rate adjustment. It helped me adjust my basal rates down or up to the correct level. It's available online or can be found in Think Like A Pancreas?
     
    • Like Like x 1
    • Informative Informative x 1
  7. paulpapa

    paulpapa Type 1 · Well-Known Member

    Messages:
    94
    Likes Received:
    76
    Trophy Points:
    58
    Thank you iHs, I have a copy of the book on my shelf so I'll have another bash in the week. Great tips, too. Makes sense to at least get some decent data. Saw my DSN today and she made some adjustments so I'll see how they go over the week.
     
    • Like Like x 1
  8. iHs

    iHs · Well-Known Member

    Messages:
    4,603
    Likes Received:
    2,320
    Trophy Points:
    158
    Basal rate adjustment table is on page 142. Adjust all your basal rates to a bg target and look to see how much your bg levels drop or increase and then using the table work out how much insulin you will need to adjust to get to the target bg you want.
    Good luck and take it all in your stride. Hotter weather might mean less insulin whereas colder weather can mean more.
     
    • Like Like x 1
    • Informative Informative x 1
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook