# Basal testing - is it all it's cracked up to be?



## MaryPlain (Jul 24, 2012)

I know the theory. You take away all the other variables and check that your basal rate is covering the background requirements. 

However.... as I am trying to lose weight, I have drastically cut back on carbs. To give you an idea, my total daily dose of insulin has reduced from 35-40 units to 20-25 units a day. What I've noticed is that my waking levels (dawn phenomenon etc) are higher on days when I've eaten more carbs the day before (even accounting for the bedtime level).

I also notice that whenever I've adjusted my basal (normally up) in the morning, when I've gone back to eating breakfast my levels are all over the place. 

Also, for basal testing you're not supposed to exercise, but I exercise every day, so just how realistic is this? 

I suppose what I'm getting at is that I think that the distinction between background or basal and bolus insulin needs is not quite as clear cut as they would have us believe. My consultant always sends me forms to fill in for a proper and thorough set of basal tests before my six monthly pump review appointment, and I religiously filled these in for the first couple of times, but it seems that she only asks to see them if my HbA1c has gone up. 

Any thoughts, experiences, or shared wisdom?


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## bigpurpleduck (Jul 24, 2012)

I feel similarly to you about basal testing. I understand the theory but worry that in practice it can't be all that accurate. Food and bolusing are only 2 variables in a never-ending list. I know my BG is heavily influenced by hormones so I could basal test today and all is well, but after I ovulate in a few days everything turns on its head. Also stress, tiredness, physical exertion, mental exertion, weather... And I have to say I think the higher the carb content of my diet the higher my basal needs. I don't think basal and bolus can be separated into black and white quite as easily as HCPs lead us to believe.

Having said that, basal testing has proved to me on various occasions in the past that it's a good idea. I have to confess to not doing it regularly, and I generally tend to only do so if I'm having some serious problems. But it does help to solve those serious problems. I have found that my basal is normally not too far off the mark, so I think carbs affect me quite adversely. Basal testing has helped me to identify the foods that cause the most problems and I have eliminated many of these from my diet. Basal testing occasionally also helps with my peace of mind - if I'm having a hard time, I test & it looks like my basal is okay then I feel a bit better and know that it's meals that are the problem.

I probably should basal test more often. But I hate it - I love my food, and when stressed if I don't eat I get major stomachache - and I struggle to fit it into my daily routine. Asides from that I do everything else I can to help myself, and by the book, so I try not to be too hard on myself about it.

Disclaimer(!): I must add that these are my opinions and experiences - yours may be entirely different and I am not saying I'm right not to support regular basal testing. It's just the conclusion that works best for me.


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## everydayupsanddowns (Jul 24, 2012)

Basal testing is an artifical construct - BUT it's an artificial construst that frequently tells me a great deal about what is wrong with my general set-up.

Whenever things are either stubbornly high, or relentlessly low 9 times out of 10 it seems to be a basal tweak that I need - and while I can wing it for a while just bumping things up or down a notch here and there I only ever seem to get really good reliable levels back it I dig in and systematically retest my basal over a week or two.

It was exactly the same on MDI - but at least not there seems more point in running a full set of tests as I'm able to make hourly changes whenever I need them.


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## Pumper_Sue (Jul 24, 2012)

Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day.
Tis a complete waste of time sitting on your bum all day as the result would be completely not right for your every day needs.
Same as work basals are normally different than non working days.
Hence why you have the choice of four or five basal patterns 
Most know that if you go low carb this affects basal insulin needs.
So if you are chopping and changing your eating habits then different results can be expected.


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## everydayupsanddowns (Jul 24, 2012)

Pumper_Sue said:


> Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day...



Interestingly I avoid basal testing on gym days (usually about 3 days a week), but changes to 'regular' days are reflected in the TBR/bolus reduction I guess.

It usually takes over a week of no gym visits (over a holiday period for example when gym visits usually fall away) for the lack of activity to really start kicking in for me.


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## MaryPlain (Jul 24, 2012)

Thanks to all for your replies, very interesting and not quite what I was expecting - thanks again.



Pumper_Sue said:


> Basal testing is done as per normal days activity. Which means if you go for a walk be it 1 mile or 3 each day at that time then it's part of your day.
> Tis a complete waste of time sitting on your bum all day as the result would be completely not right for your every day needs.
> Same as work basals are normally different than non working days.
> Hence why you have the choice of four or five basal patterns
> ...



Hi Sue - interesting - your advice sounds like common sense but goes against everything I've read and been told about basal testing re exercise.  

I'm a bit puzzled by this "Most know that if you go low carb this affects basal insulin needs" - this was news to me, and I'm not sure I'd describe my diet as "low carb" although it's certainly "lower carb" than it was! As I said, my total daily dose is between 20 and 25 units (with the occasional one below 20) but only 11 of those are basal so since my carb ratio is 1:10 that means I'm still eating between 90 and 140g carbs - would you call that low?


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## Doc_Brown (Jul 24, 2012)

I'm inclined to agree in saying that it's not black-and-white, but that it can give you a good idea what's going on.

I'm also interested in your response, Mike, as I'm about to start a few basal test days. I ride my bike cross-country to work, so sometimes about half an hour's heavy exercise. So I was planning on basal testing on my days off, like you.

However, I might just throw caution to the wind and test any old day, because when I get to work, I'm usually sitting at a desk all day...


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## Pumper_Sue (Jul 24, 2012)

MaryPlain said:


> Thanks to all for your replies, very interesting and not quite what I was expecting - thanks again.
> 
> 
> 
> ...



Hi Mary,
          have a read of this  http://www.diatribe.us/issues/13/learning-curve

Sorry I misunderstood your lower carb as low carb.
When people do the lc thing they tend to eat more fat which does affect the basal needs for a lot of people on insulin.
90 - 140 low no. I was imagining you doing the less than 50


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## MaryPlain (Jul 24, 2012)

Pumper_Sue said:


> Hi Mary,
> have a read of this  http://www.diatribe.us/issues/13/learning-curve
> 
> Sorry I misunderstood your lower carb as low carb.
> ...



Thanks for the link. I had read it before, but on re-reading found something I'd missed before - when doing a morning basal test I can't shower either because it means I have to disconnect - the reasons against are stacking up! On the other hand since showering is something I do every day.... Do others abide by this rule?


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## Ellie Jones (Jul 24, 2012)

I would agree that basal testing isn't quite as black and white, but it needs to be done and it's a case of choosing the best possible time to ensure that your results are as clear as possible..

When I was setting up my pump, my first series of basal testing were done on a low level exercise day, so avoided excessive or heavy housework, didn't go dashing off to town or into work... This gave me a basic basal to work from, so when I had to sort out my basal for my normal daily activities, I didn't have major lows or highs.. 

When I went back to work, and when I changed my job to work in kennels, I did a cheat version of basal testing...  What I did was set a temp basal setting and tested every hour, by using the information from blood testing and my temp basal rates, to adjust my pump..  worked out well and avoided unwanted hypo's and highs..

I used to do a regular basal check to ensure all was fine, now I only tend to do them if I'm having a indication that they might be sliding off skew a bit...


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## MaryPlain (Jul 24, 2012)

Ellie Jones said:


> When I went back to work, and when I changed my job to work in kennels, I did a cheat version of basal testing...  What I did was set a temp basal setting and tested every hour, by using the information from blood testing and my temp basal rates, to adjust my pump..  worked out well and avoided unwanted hypo's and highs..
> 
> I used to do a regular basal check to ensure all was fine, now I only tend to do them if I'm having a indication that they might be sliding off skew a bit...



This is intriguing - please can you tell us more about how your temporary basal rate testing works?


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## trophywench (Jul 24, 2012)

Well how many dribbles of basal are you going to miss in the few minutes a shower take? - you can always reconnect while you and your hair are still wet.


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## Ellie Jones (Jul 24, 2012)

Pretty easy really...

I knew that my basal for a normal non-working day was pretty spot on, as well as my carb/insulin ratio...  So I set my First attempt I turned my pump down by 40% noted down the reading it was saying for each hour, and tested bg...

Looked at the pattern, set up a new profile using the information with a tweak, used the profile the next day, and hourly BG, had to treat a couple of hypo's so the next day I did a 10% noted what it was delivering every hour and BG, looked at the data, a couple of tweaks, by the end of the week, had a good working profile going..

For the kennels, I actually had two different profiles set up, as working the main block of kennels was a lot harder going, than working the other blocks B&C blocks!


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## Abi (Jul 25, 2012)

Too be honest with my diabetes there are so many variables I sometimes wonder myself. My HbA1c was better 10 years ago with inaccurate carb counting and no basal testing then it is now. I checked pm rates 2 days ago and drifted from 8 to 3.7- I wonder if it was a hangover effect from weekend excercise. Then yesterday after lunch I spiked a 16. Morning basal isn't too badly off
I read somewhere that increased carb consumtion and bolus insulin definately increase basal requirements and vice versa. This was from a diabetes educator on an American website.
I still keep plodding on though with it. I'm sure it provides some useful information


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## Northerner (Jul 25, 2012)

I'm doing the ultimate basal test at the moment - I've had 2 units of lantus in the past 8 weeks!  Woke this morning to a 4.9


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## everydayupsanddowns (Jul 25, 2012)

Doc_Brown said:


> I'm inclined to agree in saying that it's not black-and-white, but that it can give you a good idea what's going on.
> 
> I'm also interested in your response, Mike, as I'm about to start a few basal test days. I ride my bike cross-country to work, so sometimes about half an hour's heavy exercise. So I was planning on basal testing on my days off, like you.
> 
> However, I might just throw caution to the wind and test any old day, because when I get to work, I'm usually sitting at a desk all day...


 

I think the caution over 'basal testing + exercise' is the likelihood of your liver wading in and royally messing things up in a not very predictable/repeatable way in that higher levels of exertion without readily absorbable carbs/bolus insulin on board can flick the liver into 'panic' mode.

Glad to see I'm not the only one who seems to struggle to find a 'normal' day to test on! It also bears out the requirement to test the same period on more than one day to make sure you aren't just chasing your tail basal-tweaking for one-off results. Best to see that there's a repeatable pattern first. 'Course that slows the process down still further


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## MaryPlain (Jul 25, 2012)

trophywench said:


> Well how many dribbles of basal are you going to miss in the few minutes a shower take? - you can always reconnect while you and your hair are still wet.


That's an interesting question. I used to know how many bursts an hour my pump delivers, but now I can't remember.  However when showering I'm probably disconnected for around 10 minutes in all (I reconnect as soon as I'm dry) which is one sixth of an hourly dose - when basal testing I would imagine that it is significant, but as I do it every day, it's probably already factored in somewhere: whether I compensate by having a slightly higher basal or whether it's covered in my breakfast bolus I don't know.  I'm just going by the advice in the link not to disconnect when doing basal testing!


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## MaryPlain (Jul 25, 2012)

Northerner said:


> I'm doing the ultimate basal test at the moment - I've had 2 units of lantus in the past 8 weeks!  Woke this morning to a 4.9



Aren't you pumping then?


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## MaryPlain (Jul 25, 2012)

Ellie Jones said:


> Pretty easy really...
> 
> I knew that my basal for a normal non-working day was pretty spot on, as well as my carb/insulin ratio...  So I set my First attempt I turned my pump down by 40% noted down the reading it was saying for each hour, and tested bg...
> 
> ...



I'm still puzzled as to why you start by reducing your basal by 40%?


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## Northerner (Jul 25, 2012)

MaryPlain said:


> Aren't you pumping then?



Nope. I do wonder though if I would need any basals set if I was on a pump, one would imagine not! Since diagnosis I have recovered some beta cell function and gradually reduced the lantus from 20 units to zero


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## Pumper_Sue (Jul 25, 2012)

MaryPlain said:


> I'm still puzzled as to why you start by reducing your basal by 40%?



The reason you set your basal back so far if you have an active job is so that you can see a pattern emerging without the hypo. It's better to reduce by to much than not enough. You still get the pattern so can then adjust and give the work profile a trial run the next day.


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## shiv (Jul 25, 2012)

trophywench said:


> Well how many dribbles of basal are you going to miss in the few minutes a shower take? - you can always reconnect while you and your hair are still wet.



Interesting q, I have often wondered the same. I saw a Dr from King's College Hospital on Monday at a meeting who suggested that for every 30 mins off the pump (showering and getting dressed), you can assume that BG rises by 1mmol.

Now I don't take 30 min showers, and I usually only have my pump off for 10-15 mins max. But it's worth taking into consideration if you are the sort who leaves it off for a longer period of time and needs to basal test.


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## MaryPlain (Jul 25, 2012)

Pumper_Sue said:


> The reason you set your basal back so far if you have an active job is so that you can see a pattern emerging without the hypo. It's better to reduce by to much than not enough. You still get the pattern so can then adjust and give the work profile a trial run the next day.



Oh, ok thanks - I thought it was some new way of basal testing. I suppose if you're having a lot of hypos it makes sense. 

On the other hand, if levels get too high, the basal test becomes unreliable anyway surely as insulin resistance increases with high bloods. I have found that if my BM goes over 8 I might as well abandon the test as it rarely recovers thereafter.


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## Pumper_Sue (Jul 25, 2012)

shiv said:


> Interesting q, I have often wondered the same. I saw a Dr from King's College Hospital on Monday at a meeting who suggested that for every 30 mins off the pump (showering and getting dressed), you can assume that BG rises by 1mmol.
> 
> Now I don't take 30 min showers, and I usually only have my pump off for 10-15 mins max. But it's worth taking into consideration if you are the sort who leaves it off for a longer period of time and needs to basal test.



But then again if this is an every day ocurance then that's what your basal will be wont it?  So it's nothing new to factor in


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## Ellie Jones (Jul 25, 2012)

If you plotted out your basal rates, you find that it gives a wave pattern, if you plot your working profile and your normal (day off profile) you often find that the actual wave pattern is very similar

The 40% is purely based on an Educated guess, and yes if I my levels had started to go high, I would abort the session, still use what info I had collected to make an educated guess on my next move though..

I was working in very busy kennels, most paying guests but also a small block of 6 kennels for Labrador Rescue.  My boss bred working dogs 'Rotti's' and our supervisor also bred and trained Working German Shepherds for Schutzhund (Sport side of police dog training) latter great fun, as long as you weren't playing the stodge for bit training..

So we catered for the difficult, ill-mannered iffy dog  So having an hypo when handling  one of these wasn't a good idea... 

So risking a high blood glucose was far safer than risking a hypo..


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## MaryPlain (Jul 26, 2012)

Pumper_Sue said:


> But then again if this is an every day ocurance then that's what your basal will be wont it?  So it's nothing new to factor in



I agree Sue, but all of the instructions for basal testing contradict this.


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## Pumper_Sue (Jul 27, 2012)

MaryPlain said:


> I agree Sue, but all of the instructions for basal testing contradict this.



I really can't see a problem in doing basal testing, I think people are finding problems when there aren't any


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## MaryPlain (Jul 27, 2012)

Pumper_Sue said:


> I really can't see a problem in doing basal testing, I think people are finding problems when there aren't any



I'm glad to hear that you don't have any problems with it, Sue. I'm also grateful to others who have posted though for helping me see that I'm not the only one who does find it difficult!

I suppose my biggest problem is that I absolutely HATE doing it. I'm very much a creature of habit, and I like my food, so basal testing is a big disruption to routine and missing meals a major deprivation. All of that is worth it of course if it helps me get better control; it's just that I'm not convinced it actually does! I think if you could just do the tests once, it would all be fine, but it's the requirement to keep on tweaking and repeating the tests when things go out that make it such a chore. I've had the situation where I've made an adjustment due to going too low or too high, then the next day it's gone the other way, and I've ended up eventually going back to the original doses.  

It appears to me, from my experience, that my body just doesn't behave the same when I fast as it does when I eat.


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## Pumper_Sue (Jul 27, 2012)

Mary,
       with respect we all hate basal testing as in skipping meals, but then we all knew it was part and parcel of having a pump. Yes I do find it hard going but then I had been on insulin for 42 years before I went on a pump. I also have addison's disease, which makes my management very hard.
Bottom line is bite the bullet and get it done


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## trophywench (Jul 27, 2012)

Yup it's a PITA, just a necessary one if we want to get the best out of our treatment whether pumping or MDI, but have to say it was hammered home at my clinic that it can't be avoided AT ALL with a pump and if you weren't prepared to do it - well don't sign the form to say you'll have the pump.


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## MaryPlain (Jul 27, 2012)

I am very grateful for the pump. I don't remember being warned about basal testing by the healthcare team before signing up for the pump though, not that it would have made any difference! I'm not sold on its effectiveness, given my personal experience, that's all. As I said before, if I knew that it would give me better control I wouldn't question it.


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## everydayupsanddowns (Jul 27, 2012)

I know at least one other person who struggles to do a fasting basal test over breakfast. They simply have to use the other time slots as information to inform educated guesses for that period. 

Do you always see wildly different responses Mary? Have you missed lunches for a whole week for example just as an experiment?

In your shoes I might find that helpful. I ran a test myself this morning oddly enough, which gave a very useful indication of the general state of things for me this week (my basals have been wandering almost weekly/fortnightly for about 6 weeks now!)


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## MaryPlain (Jul 27, 2012)

everydayupsanddowns said:


> I know at least one other person who struggles to do a fasting basal test over breakfast. They simply have to use the other time slots as information to inform educated guesses for that period.
> 
> Do you always see wildly different responses Mary? Have you missed lunches for a whole week for example just as an experiment?
> 
> In your shoes I might find that helpful. I ran a test myself this morning oddly enough, which gave a very useful indication of the general state of things for me this week (my basals have been wandering almost weekly/fortnightly for about 6 weeks now!)



Hi Everyday.... thanks for your post.  I haven't tried that - mainly because when working most days I can't do a test every 2 hours. I have to choose my days carefully - one or two times a week it is possible, which stretches the whole thing out tediously! On occasions I've started a basal test and then got side tracked with work and only remembered after managing to snatch a cup of tea that I should have had it without milk! 

While I'm off work I wouldn't have a problem missing lunch every day - I often do, but I still tend to find that at some point my liver misbehaves itself and spoils everything. People talk about only having to fast for 6 hours at a time, but when you add in the 4 hours after the last meal and bolus, it's actually 10 hours, and my liver doesn't think I should starve myself for that length of time!


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## everydayupsanddowns (Jul 28, 2012)

I know what you mean! I tend to avoid gym days (certainly don't do breakfast-lunch tests then) which usually leaves me just 2 days to choose from. Any unexpected dips below 4 on those days and I can mess up most of a week easily. Very frustrating when you know you *want* the information, but struggle to find the right days to test for it!


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## MaryPlain (Jul 28, 2012)

everydayupsanddowns said:


> I know what you mean! I tend to avoid gym days (certainly don't do breakfast-lunch tests then) which usually leaves me just 2 days to choose from. Any unexpected dips below 4 on those days and I can mess up most of a week easily. Very frustrating when you know you *want* the information, but struggle to find the right days to test for it!



I'm so glad I'm not the only one!


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## bigpurpleduck (Aug 17, 2012)

Sorry for the late response, I've been gone for a bit...

Just wanted to say again Mary that I totally feel your pain. I find basal testing so hard to fit into my routine, and the fact that I'm STARVING is all I can think about while I'm doing it.

I often wonder if my reluctance to basal test indicates that I am less committed to the cause than my fellow pumping D's... My A1c's would also suggest the same. But my priorities are right for me at this point in time. How often you basal test is a personal choice, I guess. Nobody knows you and your life better than you do.


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## MaryPlain (Aug 17, 2012)

bigpurpleduck said:


> Sorry for the late response, I've been gone for a bit...
> 
> Just wanted to say again Mary that I totally feel your pain. I find basal testing so hard to fit into my routine, and the fact that I'm STARVING is all I can think about while I'm doing it.
> 
> I often wonder if my reluctance to basal test indicates that I am less committed to the cause than my fellow pumping D's... My A1c's would also suggest the same. But my priorities are right for me at this point in time. How often you basal test is a personal choice, I guess. Nobody knows you and your life better than you do.



Hi BPD, thanks for your response, which I find reassuring.  I've gone through different phases, for example when I was doing Dafne I was a bit OCD about my levels and testing, getting through hundreds of testing strips and worrying about it all the time.  Gradually work commitments and stresses took over and I went perhaps too far the other way. I'm trying to achieve a balance now of not worrying about it all the time, but the warning signs are there, for example I've logged in every day this week to this forum, which isn't a healthy sign for me!


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## Liz! (Aug 18, 2012)

Hmmm. I've been on a pump for 12 years and have never done a fasting basal test. i have never been threatened.


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