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Thread: Checking Basal Rates

  1. #1

    Question Checking Basal Rates

    Okay, my head is absolutely spinning from reading Pumping Insulin by John Walsh ALL DAY. Way too much information overload, but it's a GREAT book.

    My question is about checking basal rates. We have never been good at this -- nor have we ever had anyone tell us exactly how to do it. Thanks to this great book, I'm going to start with checking overnight basals. I think that part will be easy (except for the lack of sleep). I won't have to have Carson skip a big meal, only a bedtime snack with carbs.

    So, lets say we get the nighttime basals set and we're able to start checking daytime basals. The book has you break it into 3 sections -- morning, afternoon, and evening. It seems like it would take several days for us just to get morning basals set, and that would be skipping breakfast every day. Then we move to skipping lunch for a few days, then dinner????

    How do all of you do that with kids?? I read one of Ellen's posts that she let her son play video games and eat scrambled eggs. I could do that for a couple of days, but it seems like it would take a couple of weeks of skipping meals every day to get this to work. Which is probably why I've never taken the time or energy to check basals this way. But I really want to get Carson more stable. And have a good system for figuring his numbers out. And I know I have to start with getting accurate basal rates.

    Any advice from people who have done it this way would be VERY much appreciated!!!!! Right now I feel like we're just "winging" it all the time with his numbers. He's 6 years old and I want things to CALM DOWN!!!
    Brenda, dx'd type 1 6/07 at age 30 while in the TrialNet research study. T-Slim 9/14, Dex 9/14, Celiac (3/07).
    Mom to Carson, age 14, dx'd at 9 months. Cozmo (1/05) Navigator (3/09), Dexcom (8/10), currently on T-Slim (4/13)
    And Mom to Henry (nond), age 11, training for the US 2024 Mens Gymnastic Team

  2. #2
    Join Date
    Oct 2005
    Location
    Central Texas
    Posts
    5,560

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    The clinic we use is really big on basal testing, but it requires eating food without carbohydrate for 8 hours at a time -- or better yet -- not eating anything for 8 hours.

    There are 6 tests we are to do and it will take a couple of weeks to do this.
    No boluses should be done in the time period. You stop if low (under 70) or above 200 and treat. Nothing to eat or no carbohydrates in the time period.

    Test 1: 5 pm to 1 am. Test at 9 pm, 10 pm, 11 pm, 12 am, 1 am
    Test 2: 9 pm to 6 am. Test at 1 am, 2 am 3 am, 4 am, 5 am, 6 am
    Test 3: 2 am to 10 am. Test at 6 am, 7am, 8am, 9am, 10am
    Test 4: 6 am to 2 pm. Test at 10 am, 11am, 12pm, 1pm, 2 pm
    Test 5: 10 am to 6 pm. Test at 2pm, 3pm, 4pm, 5pm, 6 pm
    Test 6: 2 pm to 9 pm. Test at 6 pm, 7pm, 8 pm, 9 pm

    To interpret the numbers: the readings shouldn't vary more than 30 points. If so, you change the basal rate by .1 two hours before it should take effect. For example, if the 11 pm reading was too high, the basal rate should change at 9 pm.

    We have yet to do the daytime test.

    This what the clinic says to do and we are trying it.
    Amy
    Mom to a young adult Animas Ping pumper and DexCom G4 user. 2nd year college student, now living in a co-op house. Dx'd over 16 years ago at 3 years old.

  3. #3
    Join Date
    Oct 2005
    Location
    Central Texas
    Posts
    5,560

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    This is a test plan that I received from a member of the parents e-mail list. It actually looks different, as I had to copy and paste from a Word document.

    Amended Basal Testing
    • Do NOT correct high blood sugar in between meals (if it is extreme, suspend the test and treat, make adjustments, and retest another day)

    • Eat low fat foods with known carbohydrate count

    • If blood glucose levels are hypoglycemic at any point, treat the low, suspend the test, make appropriate adjustments to the regime, and then test again another day.


    Test at each time period
    BREAKFAST
    Eat breakfast. Give breakfast insulin and correction if needed.
    Don't eat again for 5 hours

    3 HOUR MARK (from breakfast)
    If this number is hyperglycemic or hypoglycemic, your boluses need
    to be adjusted. (Either meal or correction, or both)

    4 HOUR MARK (from breakfast)
    This number should not be >30mg/dl different from the 3 hour number.
    If it is, the basals are off.

    5 HOUR MARK (from breakfast)/LUNCH
    This number should not be >30mg/dl different from the 3 hour number.
    If it is, the basals are off.
    Eat Lunch. Give lunch insulin and correction if needed.
    Don't eat again for 6 hours

    3 HOUR MARK (from lunch)
    If this number is hyperglycemic or hypoglycemic,
    your boluses need to be adjusted. (Either meal or correction, or both)

    4 HOUR MARK (from lunch)
    This number should not be >30mg/dl different from the 3 hour number.
    If it is, the basals are off.

    5 HOUR MARK (from lunch)
    This number should not be >30mg/dl different from the 3 hour number.
    If it is, the basals are off.

    6 HOUR MARK (from lunch)/DINNER
    This number should not be >30mg/dl different from the 1ST 3 hour number.
    (FROM BEFORE LUNCH.) If it is, the basals are off.
    Eat dinner. Give dinner insulin and correction if needed.
    Don't eat again until breakfast.

    3 HOUR MARK (from dinner)


    6 HOUR MARK (from dinner)/BEDTIME
    This number should not be >30mg/dl different from the previous number.
    If it is, the basals are off.

    3 HOUR MARK (from bedtime)
    This number should not be >30mg/dl different from the previous number.
    If it is, the basals are off.

    6 HOUR MARK (from bedtime)
    This number should not be >30mg/dl different from the previous number.
    If it is, the basals are off.

    9 HOUR MARK (from bedtime)
    This number should not be >30mg/dl different from the previous number.
    If it is, the basals are off.
    Last edited by Amy C.; 10-27-2006 at 10:49 AM.
    Amy
    Mom to a young adult Animas Ping pumper and DexCom G4 user. 2nd year college student, now living in a co-op house. Dx'd over 16 years ago at 3 years old.

  4. #4

    Default

    Thanks for the chart and advice, Amy!!!

    We started with checking overnight basals last night. His last bolus was at 6pm and he only had cheese for a bedtime snack.

    At 11pm he was 188 to start the test.

    Then at 1:30am he was at 258!!!!! YIKES! So I stopped the test and corrected him and will adjust his basal tonight and try again.

    He has been running high at night and I always thought the bedtime snack bolus wasn't big enough. But obviously his basal isn't right.

    It's going to take a while to figure this all out. We have one pump nurse for all of Southwest Michigan and I really don't agree with what she taught us initially. Even our endo team told us to stop calling her for advice because it was wrong. So we pretty much have been self-taught with pump therapy and I'm very glad to get this book to tell me EXACTLY what to do. I know things won't be perfect, but at least I have some guidelines to help.
    Brenda, dx'd type 1 6/07 at age 30 while in the TrialNet research study. T-Slim 9/14, Dex 9/14, Celiac (3/07).
    Mom to Carson, age 14, dx'd at 9 months. Cozmo (1/05) Navigator (3/09), Dexcom (8/10), currently on T-Slim (4/13)
    And Mom to Henry (nond), age 11, training for the US 2024 Mens Gymnastic Team

  5. #5

    Default ...

    Stop the test if:
    - BG above 250
    - BG below 70 during the day
    - BG below 90 during the night
    - BG below 100 at bedtime
    - OR simply if BG not in 80-250

    Start the test with:
    - No food at least 4 hours prior
    - No bolus at least 4 hours prior
    - No correction at least 4 hours prior
    - Last meal low in fat
    - BG withing target
    - No ilness
    - No infection
    - No severe lows prior 12 hours
    - No heavy exercise prior
    - No rebounds
    - OR simply a vanilla day

    During the test:
    - Skip the meal that starts the test period
    - Test every two hours
    - No food (Water OK)
    - No bolus
    - No correction
    - No disconnection from the pump
    - No heavy exercise
    - No emotional stress
    - No unusual hormonal changes
    - OR simply Keep all other variables as constant as possible

    Goals:
    - Observe BG to know where the basal needs adjustment
    - Until fluctuations less than 30

    * Repeat the test once more to confirm the results
    They said: "By God! (never) wilt thou cease to remember Joseph until thou reach the last extremity of illness, or until thou die!"
    He (Jacob) said: "I only complain of my distraction and anguish to God, and I know from God that which ye know not...

  6. #6

    Default ...

    You do not necessarily have to "give him nothing". You just have to have a 'carb fast' not a 'complete fast'. We use the following 'free foods' as a [skipped] lunch for instance.

    . one cup lettuce (or more) because lettuce has one of the lowest carb factors (.03) and is kinda 'oily' if you will, o smoothens the BG raise
    a couple mushrooms because mushrooms have a low carb factor too
    a little chicken breast (cooked) because it has no carb at all (not big amounts)
    1/2 hardboiled egg because it has no carbs unless eaten in excess
    some peanuts because each single peanut has .06 carb in it and the GI is 14 and also because it has oil in it thus smoothens the BG raise

    thus privide our kid with a 'colorful' lunch very low in carbs (3 carbs total)
    They said: "By God! (never) wilt thou cease to remember Joseph until thou reach the last extremity of illness, or until thou die!"
    He (Jacob) said: "I only complain of my distraction and anguish to God, and I know from God that which ye know not...

  7. #7

    Default ...

    They said: "By God! (never) wilt thou cease to remember Joseph until thou reach the last extremity of illness, or until thou die!"
    He (Jacob) said: "I only complain of my distraction and anguish to God, and I know from God that which ye know not...

  8. #8

    Default ...

    HOWTO check your Basal Rates
    http://insulin-pumpers.org/howto/baslr.html

    INSTRUCTIONS
    http://insulin-pumpers.org/howto/basal1.html

    Insulin Pumper's Basal Rate Estimator(HOWTO estimate new Basal Rates)
    http://insulin-pumpers.org/howto/basal.cgi
    They said: "By God! (never) wilt thou cease to remember Joseph until thou reach the last extremity of illness, or until thou die!"
    He (Jacob) said: "I only complain of my distraction and anguish to God, and I know from God that which ye know not...

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