Testing, One, Two

Thursday, June 07, 2007 | 5 comment(s)

I've figured it out.

I know what makes diabetes so difficult:


Today I did a basal rate test.
And it clearly showed that I could acheive near normal blood sugars for a decently long time... if only I didn't eat anthing.

It's been about a year since I tested my basal rate settings. Before then, I had been on an insulin pump for almost 5 years and had practically the same 2 (TWO!) basal rates since the day I first started the pump. My endocrinologist at the time urged me to do some basal rate tests when I first started, but I always wimped out.
I tried, honest
After 20-some years of living with diabetes and having to eat each-and-every meal, often in exact time increments, and to be force-fed snacks in between meals, the whole concept of fasting was completely foriegn to me.

I tried a few times, but I would break out into sweats and get what I would describe as symptoms of hypoglycemia even though I was coasting in around 180 or something ridiculous like that.


Before going on my pump, I was told how much better my control could be with it. But rather than improving my control, it actually got worse when I went on a pump (and I attribute at least part of that to the inaccurately set basal rates). I certainly liked not having to take 4-6 needles per day, but I was pretty non-plussed about the lack of improvement.

When I upgraded from my Minimed 508 to the 515, I was looking forward to taking advantage of the built-in bolus wizard. This meant that I REALLY needed to get all my basal rates figured out first. I knew that I needed to start with a solid foundation (i.e., a base) before I could even try to figure out my carb ratios. Without this base in place, even if I were to figure out some carb ratios, they wouldn't be exactly right because they would potentially (i.e., very likely) be incorporating some over- or under-coverage in my basal rates. Without this baseline of insulin coverage personally tailored, I don't think one can get nearly as much out of a pump as they should. This is the one piece of unsolicited advice that I dole out rather regularly when I meet (most likely via email) someone who is about to start on a pump. Getting your basal rates set can be tough, but it is very important to put in the effort and do 'em. It took me over 2 months to figure it all out. A lot of fasting and testing and retesting. I remember feeling frustrated when I would go low during a basal rate test because I knew that meant that I would have to start all over again in a few days. But there was also a bit of twisted relief because then I could eat!

Intellectually, I knew what I needed to do. But sometimes there is a significant gap between theory and implementation (and this just so happened to be one of those times). To help me bridge that gap, I decided to work with Gary Scheiner at Integrated Diabetes Services. In case you don't know Gary, he is great. He's a CDE and works remotely with clients to help them with their diabetes management. To be able to work with a fellow diabetic who was always an email or phone call away with assistance to help figure out my basal rate and carb ratio settings was remarkable. Really, I can't stress this enough. The current structure of meeting with an endocrinologist once every 3 months, for 20 minutes (max) is just ridiculous. That's not enough time. If you're feeling like you can't figure out something specific with your treatment plan, I highly recommend working with Gary to help out. It wasn't very cheap, and it wasn't covered by my insurance, but the benefits were huge, and it's hard to put a price on the long-term effects better control will have for me. While I still haven't gotten to my goal of an A1c reading below 7 (or 6.5), I do give him a lot of credit for helping me get as close as I have to that goal (one of these days I'll get there!).

After working with Gary for about 3 months, my 2 basal rates were replaced with 8(!).

Over the past few months, however, I've been noticing my blood sugars take a pretty significant drop on a semi-regular basis right before lunch. I knew that the first place to start in figuring out what is going on was to retest my basal rates (I've been putting this off for a while now).

But this morning, I woke up at 115 mg/dl (which was exactly where I was when I tested at 2:15am as well), and I decided at the spur-of-the-moment that I was going to do a basal rate test today. I biked into work so I didn't have to worry about trying to shower
Sleepy Logic
Upon waking up, I thought this was a good thing. What I didn't realize was that I wouldn't be able to pull off any sort of awkward shower at work, and so I would be kinda gross at work. And to make matters worse, I rode my bike home from work last night and didn't exactly shower before going to bed. I was, what Megan likes to call, a dirty bird today.

Oh well. I stayed in my office and didn't eat lunch with others (I was fasting, see?) so I shouldn't have offended too many people.

while connected to my pump (you can't disconnect from the pump during a basal test).

My blood sugars stayed rock solid from 2:15am through 3:15pm. I was thinking I would hold out as long as I could without eating, but I finally broke down and had to eat something before biking home. The spike that came after eating was impressive. I under-bolused a little for what I ate because I knew I was going to be biking home while my insulin was peaking. Just as I planned, though that exercise knocked it down into range in no time. I'm pretty proud, actually. It's 9:30pm, after a rather unhealthy dinner of a PB&J, and I'm sitting here at 122 mg/dl. To quote Col. John "Hannibal" Smith: "I love it when a plan comes together."

If only we didn't have to eat... life would be so much easier.

5 Comment(s):

Blogger Bernard said...


Recently I decided the same thing. I did some basal rate testing in the last month or so. With the Dexcom it was a lot easier (though it was probably also less accurate).

Thanks for the information about Gary. Maybe I'll work with him to see if I can get things better. I'm stuck with 3 rates and I can't believe they're the 'right' ones.

One (small) change I've made that helps a lot. Pepperidge Farm now makes some 'light' breads. What they've done is reduce the cross-section of the loaf and make the slices thinner. So now a slice of Light 7-grain is 9g with 1g of fiber. Two slices of Light is exactly the same as 1 slice of the old stuff. This has been great for lunch when I normally bring sandwiches to work.

Combine that with Symlin and it's helped reduce the peaks a great deal.

Blogger Scott K. Johnson said...

I am SO with you on this one. Food sucks. But I love it.

Same deal for me. If I didn't have to eat anything I could be a stand-in actor for a non-diabetic. Well, unless I bump into any spiders...but that's a whole 'nother story.

Gary rocks. While I haven't worked with him in person yet I'm a big fan of his books and had the opportunity to chit-chat with him a time or two. I too highly recommend him, and when I get some $$ in my pocket that might be a good place to spend it.

Blogger Wingman said...


Great post! This will definetley help me out alot when I receive my first pump next week. I would have no clue how to manage this disease if I only met with my endo once every 3 months. I go to the Naomi Berrie Center and interact with them a couple times a week via e-mail - they are absolutley wonderful.

I wonder how many basal rates I'll have - and yes food is a wonderfully evil thing.

Anonymous Anonymous said...

This entry really sums it up. I've had the same experience with basal testing...in fact, I really need to do it again.

Although, I've learned that trying to do an entire day without eating actually gives me basal rates that are a tad too low for days when I'm eating at least a couple of times a day (which is virtually every day). It doesn't quite seem possible to totally divorce the effects of bolus insulin from the effects of basal insulin in that way.

Blogger Dee said...

This is so true. I tested my morning basals on Sunday, no brekkie and I was steady from 8am to 1pm. On a normal eating day, my sugars shoot up after breakfast. If I am ill I can go 24 hours with almost no fluctuation in levels at all.

Post a Comment || Go Home