# Fasting & Basal Testing



## bigpurpleduck (Sep 1, 2010)

Hi all,

Just wondered if anyone feels the same way as me about this!

I've been on my pump for over a year, and only ever tested my basals by fasting way back in the beginning. I absolutely DETEST it. For 16 years my body had been used to 3 meals a day plus regular snacks to keep my BG up. Asking it not to eat for more than 3 hours was not fun. My stomach just could not cope with it. It was actually painful.

I also feel that it won't necessarily produce correct results. Surely your insulin requirements are different when you're starving as opposed to when you've eaten?

However, I'm made to feel guilty for not fasting every time I visit the hospital.

Just wondering if anyone else feels the same?

Em


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## everydayupsanddowns (Sep 1, 2010)

Not pumping so this may not count 

Only came across the concept of fasting-to-test-basal this year. Previously I'd only ever been told the fbg rule of thumb (if fbg is ok, basal must be about right)

Basal tests have been a real lightbulb moment for me. They have helped me to understand what I have previously thought completely random results (either stubborn highs or persistent lows).

I now believe my basal requirements to be far from fixed, and will move up and down by a unit or so every few months.

My other observation is that when basals are right, everything clicks into place far more easily. Bolus ratios are far more predictable and solid. When they are wrong I can bang in units of Humalog correction with no apparent effect (I have no idea how this can be the case).

I only ever do it one meal at a time for a few days to see whether basal is holding my levels steady over that period, and choose only regularly-active days, so I don't find it too difficult.

M


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## tracey w (Sep 1, 2010)

Its difficult I know, but you only get true results if your fasting im afraid.

Recently i had to do 6 basal tests over 7 days, as the dsn forgot to send out the forms earlier  ot fun, I was working most of the days too. But it was worth it as most of the basals were correct and the ones that wernt i tweked. Good luck with it.


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## Twitchy (Sep 1, 2010)

Haven't had to do this yet, but I do know what you mean about painful when not eating!  30+ yrs of regular meals & carby snacks & even reducing carbs to try & aid weight lose has been really really hard   Think I'm a carb addict! 

Do you have to totally fast (nil by mouth bar water etc!) ?  Just wondering if you could have salad with something like hard boiled eggs to at least put something in your stomach to stop the cramps?... Sounds like they are worth the trouble though... best of luck!

Twitchy x


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## bigpurpleduck (Sep 1, 2010)

Twitchy said:


> Haven't had to do this yet, but I do know what you mean about painful when not eating!  30+ yrs of regular meals & carby snacks & even reducing carbs to try & aid weight lose has been really really hard   Think I'm a carb addict!
> 
> Do you have to totally fast (nil by mouth bar water etc!) ?  Just wondering if you could have salad with something like hard boiled eggs to at least put something in your stomach to stop the cramps?... Sounds like they are worth the trouble though... best of luck!
> 
> Twitchy x



No, it's not a complete fast, just no carbs. As much water & non-carbs as you like. But I am most definitely a carb addict, & don't feel like I've eaten much unless I do have carbs.

Up until this point I've just refused to fast. On the few occasions I did it when I first got the pump, I didn't really feel like it told me anything I didn't already know. And I don't think my control is terrible - so I feel like the discomfort I go through when fasting just isn't worth it for the data I get.

Also, I find it really impractical, especially when I'm working. I barely have enough time to throw cereal & milk in a bowl and shove it down my neck before I leave the house, so couldn't do egg & bacon as suggested by my doc. And I certainly couldn't eat nothing at all - I'd get halfway to work and collapse in a heap from the hunger. Skipping breakfast is just not an option.

It seems as though most people do fast. How in the name of hell do you guys manage it?!


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## rossoneri (Sep 1, 2010)

bigpurpleduck said:


> ...
> Just wondering if anyone else feels the same?
> 
> Em



I would have to agree that the fasting is tough and can be unpleasant.  It is also counter-intuitive to the normal type one approach.  I too lost my inclination towards doing them after the initial efforts to get the basal rate correct.

As I grew into using the pump however I started to hit occasional problems.  I tended to resolve these matters by making minor adjustments to the basal and/or bolus rates.  This worked to a degree but I was always left with a nagging doubt that matters could be better still if I repeated the fasting procedure.  Eventually the nag became too much and I fasted again.  Although the result was that my settings were not adjusted too much I felt it was a worthwhile exercise because I then had much greater confidence that I had done what I could to get the most accurate settings.  I plan to continue working like this from now on.

If however you really do not want to do the fasts then attempting them might just become counter-productive for you.  Maybe it would be worthwhile discussing it further with your DSN explaining your reservations, if you have not already.  They may be able to suggest an alternative approach or advise whether a shorter fast would suffice for you.  



bigpurpleduck said:


> ...
> Surely your insulin requirements are different when you're starving as opposed to when you've eaten?
> ...


I believe it is true that after so long the fast itself does compromise the results.  I was told that it would be pointless extending the fast beyond 18 hours.



Twitchy said:


> ...
> Just wondering if you could have salad with something like hard boiled eggs to at least put something in your stomach to stop the cramps?...
> 
> Twitchy x


Yes the guidelines for me were for a zero carb fast too.  Be careful though if you want to keep it strict, tomatoes and their like do have a few carbs and also watch the milk in coffee and tea!  

When having a Cholesterol blood test at my GPs they expect me to only have water, black tea and/or black coffee for their fast, normally about 12 hours!!  



bigpurpleduck said:


> ...
> How in the name of hell do you guys manage it?!


For a night basal I just try to find things to keep me districted and hope to get some sleep between the night alarms.  Just avoid counting down the seconds to the end.  And indulge in a big carb treat at the end (hoping not to mess up the balance too much)!!

One problem I find is that my BGs rise by themselves whenever I drive before having some carbs.  I therefore try to save the night fasts for the weekend.


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## shiv (Sep 1, 2010)

I agree, I hate the fasting tests. But to be honest I don't really see how you can basal test without fasting - the whole point is to see what your background insulin is doing, how can you do that if you eat carbs and have to bolus for them, as then you'll have the bolus insulin running around?

Would it be easier to do really small basal tests - overnights are generally easiest as you can eat your normal meal and then just test overnight, but say if you wanted to do a morning one you could have a no carb breakfast and then basal test for 2 or 3 or 4 hours so get some picture of what's going on. Or if it's an afternoon one, snack mid-morning, and have no carb snacks through the afternoon to keep you going?

Personally I don't see the need to do one huge great big fasting test, I appreciate every day is different but if you can do a few different tests on bog-standard days (whatever bog standard is for you!!) then that would be way easier than going all out and not eating for a ridiculous amount of time.


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## bigpurpleduck (Sep 2, 2010)

rossoneri said:


> I believe it is true that after so long the fast itself does compromise the results.  I was told that it would be pointless extending the fast beyond 18 hours.



18 HOURS?!!! Holy crap!! I really struggle after 4!


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## rossoneri (Sep 3, 2010)

bigpurpleduck said:


> 18 HOURS?!!! Holy crap!! I really struggle after 4!



LOL that was my reaction the first time my GP's receptionist told me I would need to go foodless for 12-14 hours when they first asked me to do a fasting blood test for a cholesterol reading.

I took another look at the guidelines I have from my DSN for the basal fast tests just to make sure I had not got it completely wrong.  Yes it does suggest fasting up to 17-18 hours after having the "last" carb meal (the testing starts two hours afterwards), but you can have non-carbs in that time!  I have done some fasts about this length and some shorter ones, it depends on the circumstances and how keen I was feeling at the time.

To be honest the bigger concern for me is making sure I get the sleep side sorted.  Sometimes I will sleep through the alarm or feel too tired to be bothered about doing a blood test and drift back off.  Or I cannot get to sleep, which then compromises the measured results because the basal rate required for being asleep is different to that for lying awake in bed getting stressed!


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## tracey w (Sep 3, 2010)

*18 hours !!!!*

not a chance! not necessary either.

I do my basal test in blocks of about 4-6 hours, dont eat anything 2 hours previously. You need to fast for the test to be accurate, obviously abandon if you get too low or too high.

I recently did around 6 tests over a week, just one time block per day.

You can find out all about the time blocks used etc in pumping insulin a great book. But all basal tests follow the same principles.


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