Basal testing - struggling to get started

[ArtemisBow]

A bit of background: I am currently 16 weeks pregnant, and was started on an Insight pump just over two weeks ago. Pregnancy has really kicked my honeymoon into overdrive – in the run up to starting the pump I was having hypos most nights and quite a few in the day. I was started on just 5 units a day basal rate, using the suggested adult profile as a start point, and for the first week it seemed pretty good. I stopped having the night time hypos apart from one after exercising, and things seemed to be a lot more stable in the day too.

From last Friday, I started to get the hypos back again – overnight from about 2am to 6am, and a lot across the day again.

On Sunday evening I adjusted my basal rate down to 4 units a day, still in the same profile. Across Monday to Wednesday I was ok most of the day but still got hypos overnight between 2am and 5am, and between 5pm and 7pm every day. Last night I edited the rates down from 11pm to 2am and 3pm to 5pm, so my total is now about 3.8 units a day basal.

Overnight I was ok, and then I wanted to do a basal test this afternoon to see if the 3-5pm adjustment had fixed things. So I ate my lunch at 10am with the idea to start the basal test from 2:30pm. Unfortunately, by the time we got to 2:30pm, I was at 3.7, which means I had to treat the hypo and cancel the test.

How can I even get started with basal testing when I can’t stop going hypo? I really want to make the most of this amazing pump that I’ve been given, but my sensitivity at the moment is so severe and the target window for pregnancy so small that I don’t know how I can do a proper test, and therefore work out if the hypos are basal related, bolus related or just random pregnancy ones. Would I be better to just try and get through the next few weeks until my resistance increases a bit in the second trimester?

Any advice gratefully appreciated!

 

[tim2000s]

A good place to start would be when you get up in the morning. Don't eat breakfast as you are already fasted. All movements from there would be related to basal insulin.

And if you can afford it, get a Libre. It will give you so much insight into what's happening that you'll probably be able to adjust things without too much basal testing, given the issues you are facing.

 

[ArtemisBow]

Hi Tim - fortunately I already have a libre, which is what has enabled me to see what's going on overnight. I can only do fasting in the morning on non-work days, because I don't wake up high enough to drive to work - which is why I was trying to do an afternoon test today. I can try a morning fast at the weekend though.

 

[iHs]

Hi
Try and basal test at the weekend. Glucose tabs and lucozade are very short acting so dont tend to linger in the bloodstream for very long so a basal test could probably be ok to do 2.5hrs later but dont overdo the glucose. I usually need 2 jellybabies for most low bg levels. Also, there will be times when you will need to adjust the basal or tweak it so keep that in mind and don't worry too much when bg levels start to change and there isn't an obvious reason.

 

[azure]

Hi @ArtemisBow I'm guessing you've already checked with your DSN and midwife, and have been given the 'OK' but I personally didn't basal test when pregnant because I didn't want to miss meals or snacks.

Your case may be totally different so feel free to ignore this - it's purely information about me not advice for you - I didn't skip meals or snacks but I tested lots and adjusted my basal (and boluses) very gradually as necessary until my blood sugar was ok. Obviously that's not the right way to basal test and maybe on occasion I altered basal when I should have altered my ratio, or vice versa, but my HbA1C was excellent and all I aimed to do was keep my blood sugar in range as much as humanly possible day and night, and avoid scary hypos (although I accepted I'd have some lows early on).

I never looked at the total daily basal and just took a bit off each basal in order to, say,,reduce it by one unit, I reduced it hour by hour to deal with specific lows or highs. So some hours stayed exactly the same, but others would be altered quite a bit gradually over the days.

 

[azure]

Just thought to say that at one point of my pregnancy, I basically got up to test and eat at 2am because I'd reduced my basals overnight gradually day by day by day and was still having lows. I've had Type 1 more than 20 years but those pregnancy hormones made me super-sensitive to insulin, and I almost felt like I hardly needed any at all : D I could have spent a couple of weeks fiddling about with my basals overnight, but as things were changing so quickly, I lt I would never catch up. As I was testing at 2am anyway, if my blood sugar was below a certain level I simply ate. I found it a whole lot easier and far less stressful.

I hasten to add that, of course, I'm not talking about bad hypos - just those persistent lows of pregnancy.

 

[Deleted member 83869]

I agree with azure! In first trimester your requirement for Insulin does go down a lot! Just work closely with your team! It could also be your ratios aswell though!
I'm in my second trimester now and my insulin has gone right back up again! Xx

 

[fozzie84]

I can't speak from a pregnancy point of view, but from my experience of basal tasting I would say if you want to do some basal testing and find you keep having that hypo after your early lunch you might want to gradually reduce your basal to try and rid you of the hypo, which would then allow you to test during the time you were actually aiming for. Although I would speak to your nurse as well, as I have no pregnancy experience and I know you have to be even more careful with everything, and as ohitsnicola said it could be ratio related, so definately worth a chat with your nurse to see what she would recommend.

 

[ArtemisBow]

Thanks all for your replies - my DSN and consultant said it would be ok to do some testing by either missing one meal in a day or eating a no carb meal like chicken or hard cheese (although I think these would still raise blood sugar, just not as much).

I don't think you would normally basal test while pregnant, as ideally you would do this all BEFORE the pregnancy, but unfortunately that wasn't an option.

I think for now the better option may be to do as you did azure and tweak basal or bolus based on time of day but keep eating, and just hang in there until the sensitivity comes down a bit. In theory that should happen across the second trimester. I will call my DSN today and check she is aligned with this.