Tuesday, July 18, 2006

The Diabetes OC motivates me! When I read that some people do their basal tests by simply not eating, I thought, "that's a good idea." I have always hated those tests and have not done one since shortly after I got the pump. It's not so much that they're inconvenient as that they're another reminder of the inconveniences of having diabetes. (Circular logic, maybe, but then, I got a "C" in logic).

So, I was pumped (hah!). I was going to do this. I was going to (gasp) skip breakfast. Today was my day.

I woke up at 204. Yesterday I was 203. The day before that was 124. So either the heat is doing its thing or I need more on the 2:30 - 5:30 am set. I gave a slight bolus to correct the 204, tell myself that if I woke up high I should skip the test, and then ignore my advice. I've prepped myself for this and I am going to do it. (So rarely do I try to be a "good diabetic").

Then I debate -- do I go for a powerwalk or not? On the "Yes" side: It's my Tuesday form of excercise. I will feel badly if I don't. I'm 204. On the "No" side: I'm 204. I might go low. I'll skewer my results. I go with the "yes," and compromise with the fear of lows by suspending my pump.

I come back at 257. Later I am 255.

I throw in the towel. Eat some chicken bryani. Do what I think is enough insulin. Clock in at 258.

So, for once in my life, I am remarkably consistent. But I haven't learned anything. Are my basals off? (They weren't last week...) Did I screw up with the walk/suspend? Did I miscalculate lunch? Are my consistent highs a result of the weather, hormones, a bug I'm fighting? Who can tell?


Scott K. Johnson said...

Who can tell is right.

I think waking up outside of your target range, you probably should have not done the test.

It has been a long (long) time since I've tested my basals, but the key to a successful basal rate test is to eliminate variables. Eliminate things that would cause your BG's to spike or drop that are not your basal rate.

So, for example, your correction bolus after waking up. How can you know if your basals are doing their job, when you've got that bolus involved? Same thing for the walk too - it will have an effect on your rates.

Now, if you do that walk EVERY DAY, then it's not necessarily a variable! Do you see what I'm getting at? It's hard to describe, or maybe I'm just having a hard time with it.

You need to be confident that any rise or drop in your BG is a direct result of your basal rate, and not something else.

Then, it's always a safe bet to not make any changes unless you see the same result again in another test.

So, let's say you wake up, and test 100, don't eat, don't bolus, just start your day. In an hour you go up to 130. Ok, that's one days result.

Test again the next day. You wake up at 120, and in an hour you are 150. Super - you got the same 30 point increase on both days. Then you can look at making some changes - because your results were pretty consistent.

Does any of this make sense? Please let me know if you need me to elaborate any more - I'll do my best. Always remember too - I'm no doctor - just a random internet friend. In other words - this is not professional medical advice, just my opinion on the situation.

All the best!

Nic said...

Hi, Scott. It all makes total sense. And I really didn't think I should do the test, given the high bg, but at the same time, I _wanted_ to do it for the first time EVER. And that seemed important, too. Another variable: my attitude as a diabetic!

Kevin said...


Basal testing is one of those things that is SO important to do. I was on a pump for 5 years before I actually did mine.

I tried to do them in the beginning but always flaked out because of hunger or symptoms of hypoglycemia that weren't really hypos (they were just signs of my body complaining about not getting food on its regular schedule that it has been expecting over the previous 25 years).

During those first 5 years on the pump I basically had just two basal rates, my blood sugar control was erratic, my A1c was solidly in the 8s, and I felt like my management effort was a complete shot in the dark. Very frustrating.

I buckled down, sought help from Gary Scheiner (a CDE with diabetes who offers long-distance services through his company integrated diabetes services) and actually did the tests. It took me about 3 months to get them set correctly.
And I now have 9 different basal rate settings (what's the point of being on a pump if you only have 1 or 2 basal settings? you can get that kind of coverage with Lantus).

I highly recommend finding the resources to do this (either with your current CDE or with Gary). Having someone review your blood sugars on a daily basis while your doing your basal test is INVALUABLE.

Keep that motivation up! With basal rates appropriately set, things make more sense (though that's not to say they always make "perfect" sense).

Good luck!